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MILTC^  M.   LEXM\RD,   D.V.M. 


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OUTLINES 


OF 


Clinical    Diagnostics 


OF  THE 


Internal  Diseases  of  Domestic  Animals 


BY 


Prof.  Dr.  Bernard  Malkmus 

Professor  of  Theory  and    Practice  and  Director  of  the  Clinic 

for  Internal  Diseases  at  the  Royal  Veterinary 

College  of  Hanover,   Germany 

SECOND   EDITION— REVISED   AND   ENLARGED 


Translated    from    the    Latest,    Revised    German    Edition   by 

David    S.    White,    Dean    of    the    College  of  Veterinary 

Medicine,    Ohio    State    University    and    Dr.    Paul 

Fischer,  State    Veterinarian   of    Ohio 


CHICAGO 
ALEX  EGER 

1909 


COPYRIGHTED    AT 

WASHINGTON,    D.    C. 

BY  ALEX.  EGER 

1908 


Authorized   Translation 

Translator's  Preface, 


IN  the  translation  of  ]\Ialkmus"'Grundriss  der  Klinischen 
Diagnostik"  we  have  endeavored  simply  to  reproduce 
the  author's  ideas  with  the  hope  that  the  English  and 
American  Veterinary  Students  may  thus  be  provided  with 
a  text-book  for  which  they  have  long  felt  a  need.  The 
needs  of  the  students  in  the  College  of  Veterinary  Medi- 
cine of  the  Ohio  State  University  have  been  the  direct 
cause  of  the  hurried  undertaking  of  this  work.  A  few  short 
notes  which  we  thought  proper  to  add  here  and  there, 
throughout  the  book,  have  been  placed  in  [  ]. 

Columbus,  O.,  David  S.  White, 

January,  1908.  Paul  Fischer. 


Preface  to  the  Third  Edition. 


THE  favorable  reception  which  this  work  has  met  is 
emphasized  by  the  fact  that  it  has  been  translated  into 
iDOth  the  English  and  French  languages.  I  am  convinced 
that  the  concise  manner  in  which  I  have  presented  the 
subject  of  clinical  diagnostics  has  received  friendly  recog- 
nition from  practitioners.  In  re-writing  the  third  edition 
I  have  endeavored  to  include  everything  which  would  con- 
tribute toward  making  it  more  complete  and  better.  To 
this  end  all  recent  clinical  observations  and  new  methods 
of  examination  have  been  employed.  The  number  of  illustra- 
tions has  been  increased;  and  a  table  in  color  of  the  quanti- 
tative determination  of  indican  has  been  added. 

Hanover,  April,  190G.  Malkmus. 


Preface, 


nPHE  only  safe  foundation  for  the  treatment  of  anima! 
*  diseases  is  a  correct  diagnosis  of  the  malady.  In 
therapeutic  as  well  as  in  forensic  veterinary  medicine 
everything  depends  on  a  correct  recognition  of  the  disease. 
This  is  the  most  difficult  part  of  veterinary  medicine,  and 
methodical  training  alone  will  enable  the  student  to  de- 
velop into  a  practicing  veterinarian  who  can  do  justice  to 
this   demand. 

The  following  little  work  which  offers  a  great  variety 
of  material  in  a  most  condensed  form  is  intended  as  a 
guide  for  the  diagnostician  in  recognizing  and  understand- 
ing the  symptoms  of  disease.  Although  it  represents  the 
result  not  only  of  personal,  but  of  veterinary  experience 
in  general,  for  the  sake  of  clearness  and  general  appearance 
the  names  of  the  numerous  authors  have  been  omitted. 
The  results  of  bacteriological  research  which  have  an  im- 
portant bearing  on  diagnostics  have  been  given  due  prom- 
inence. I  have  also  deemed  it  appropriate  to  call  attention, 
at  the  proper  places,  to  those  diseases  or  conditions  which 
are  considered  as  factors  in  annulling,  or  setting  aside  a 
sale.  It  was  necessary  to  append  a  brief  description  of  the 
most  common  diseases  in  order  to  give  the  student  a  gen- 
eral idea  of  the  character  of  the  maladies  that  affect  the 
various  functional  apparatus,  thus  refreshing  his  memory 
and  enabling  him  to  institute  comparisons  between  what 
he  learns  from  his  lectures  and  sees  in  the  clinic. 

The  true  to  life  representations  of  the  horse  and  cow, 
which  are  copied  from  the  "Handbuch  der  Anatomic  der 
Thiere  fur  Kiinstler,"  I  owe  to  the  kindness  of  Prof.  Dr. 
Ellenberger  and  Prof.  Dr.  Baum  of  Dresden.  I  here  most 
kindly  thank  these  gentlemen  for  their  unselfish  obliging- 
ness. 

The  publishing  house  of  Gebriider  Janecke  have  dis- 
regarded both  expense  and  trouble  in  order  to  supply  good 
illustrations  and  to  give  the  book  a  neat  appearance ;  to 
them,  too,  my  gratitude  is  due. 

Hanover,  November,  1898.  Malkmus. 


Table  of  Contents. 


PAGB 

The  Diagnosis  of  Diseases    11 

Symptoms    12 

Determining  the  Diseased  Organ   14 

The  Recognition  of  the  Disease 15 

I.     Anamnesis   18 

II.     Determining  the  Status  Praesens 21 

Method  of  Examination. 

Inspection    21 

Palpation    23 

Percussion    24 

Auscultation    29 

A.     General  Part  of  Examination  31 

1.  Signalment     31 

2.  Habitus    32 

^           I.     Attitude  of  the  Patient   33 

'^         II.     Condition    38 

*^      III.     Conformation    39 

IV.     Temperament    40 

Diseases    which    are    character- 
ized  particularly    by    change 

in    Habitus    41 

3.  The  Skin   43 

I.     Condition  of  the  Hair  Coat 43 

II.     The   Skin's   Moisture    44 

HI.     Color  of  the  Skin 45 

^    IV.     Condition  of  the  Skin 46 

^     V.     Swellings  in,  and  immediately  under, 

the  Skin .^ 47 

Diseases    of    the    Skin 49 


VIII 

4.  Examination  of  the  Conjunctiva   57 

1.     Discharge  from   the   Eyelids    59 

II.     Color    ': 59 

5.  Bodily  Temperature   62 

I.     The   Xormal  Temperature    64 

11.     Temperature  of  the  Skin   65 

III.     Fever    65 

IV.     Subnormal  Temperature   70 

General     Infectious     Diseases...  TO 

B.     Special  Part  of  the  Examination.  73 

6.  Circulatory  Apparatus    73 

I.      Pulse    73 

11.     Examination  of  the  Peripheral  Plood 

Vessels    79 

111.     The  Pleart   81 

Diseases  of  the   Circulator}-   Ap- 
paratus   88 

7.  Respiratory   Apparatus    90 

^-  I.     The  Respiratory  ^lovements 91 

II.     The  Breath   .  .  .' 100 

III.     Nasal   Discharge    10-3 

IV.     The    Nasal    Cavities    and    Adjacent 

Sinuses    106 

V.     Examination    of    the    Submaxillary 

Lymph   Glands    .•'.    109 

VI.     Cough  ' Ill 

VII.     The  Voice 115 

VIll.     The  Larynx  and  Trachea   115 

IX.     Percussion  of  the  Thorax   118 

X.     Auscultation  of  the  Lungs   124 

Diseases       of       the       Respiratory 

Apparatus 129 

8.  Digestive  Apparatus   133 

1.  Food  and  Drink   134 

11.  The  Buccal  Cavity   139 

III.  The  Throat  and  Esophagus 142 

IV.  Rumination 143 

V.  Vomiting    144 

VI.     The  Abdomen   145 


IX 

VII.     The  Intestinal  Evacuations   156 

Diseases     of     the     Digestive     Ap- 

'        paratus 163 

9.     Urinary  Apparatus   167 

*-           I.     Manner  of  Voiding  the  Urine 168 

11.     Examination  of  the  Urine 170 

A.  Macroscopical  Examination   .  .  .  170 

B.  Chemical    Examination    173 

C.  Microscopical  Examination. 

A.  Crystalline       Constituents       of 

Urine    184 

B.  Organized  Elements  of  Urine.  .  186 

III.  Examination  of  the  Urinary  Organs  189 
Diseases    of    the    Urinary     Appa- 
ratus    191 

10.  The  Sexual  Apparatus    192 

I.     Abnormallv  Increased  Sexual  Appe- 
tite     ' 192 

11.     The   Vulva    , 193 

III.     The  Vaginal  Mucous  Membrane...  194 

IV.  The  Udder 194 

V.     Diseases  of  the  Male  Sexual  Organs  196 

Diseases    of    the     Sexual     Organs  196 

11.  The  Nervous  System   197 

I.     Psvchic    Functions    199 

II.     Sensibilitv    201 

III.     Motility    202 

Diseases   of  the  Nervous    System  207 

C.     Specific  Examinations.  209 

12.  Body  Movements  209 

(^              I.     Examination  for  Immobility   209 

II.     Examination  for  Heaves   212 

III.     Examination  for  Roaring 214 

IV.     Examination  for  Epilepsv  and  Ver- 
tigo     ' 216 

V.     Examination  for  Balkiness 217 


X 


13.  Diagnostic  Inoculation   218 

I.     Tuberculosis    219 

II.     Glanders    222 

III.  Anthrax,    Blackleg,    ^lalignant    Ed- 

ema and  Wild-und  Rinder-Seuche  226 

IV.  Rabies    227 

14.  The   Lymphatic    Glands    229 

15.  The   Blood    231 

Diseases    of    the    Blood 235" 


The  Diagnosis  of  Diseases. 

The  object  of  practical  veterinary  medicine  is  manifold,, 
but  in  the  main  it  consists  in  the  restoration  of  the  destroyed 
health  of  our  domestic  animals.  For  this  purpose  a  knowledge 
of  the  afTected  organ  and  of  the  character  of  the  disease  is 
indispensable,  because  this  knowledge  offers  the  only  safe  basis 
for  a  rational  treatment  and  a  correct  prognosis. 

Thus  the  art  of  making  a  correct  diagnosis  is  not  only  the 
foundation  upon  which  practical  veterinary  medicine  rests,  but 
it  is  pre-eminently  that  which  elevates  medicine  to  the  dignity 
of  a  science. 

Diagnosis  is  the  art  of  determining  in- 
ternal changes  of  the  bod}-  b}-  the  aid  of 
externall}'  visible  or  otherwise  appreci- 
able changes  in  the  animal's  condition 
or  some  of  its  organs.  It  also  includes 
the    recognition    and    name    of    the    disease. 

Since  disease  is  a  deviation  from  normal  conditions  and 
physiological  processes,  morbid  changes  cannot  be  recognized 
without  a  knowledge  of  normal  conditions. 

In  the  classroom  the  student  has  no  opportunity  to  study 
the  physical  characteristics  and  the  physiological  functions  of 
organs  in  living  animals ;  he  must  learn  this  from  personal  ob- 
servation and  investigation  in  the  clinic.  In  the  clinic  he 
must  cultivate  his  senses  and  learn  to  hear,  see,  feel  and  smell 
in  order  to  be  able  to  judge  correctly. 

In  the  course  of  his  practice  different  species  of  animals 
are  presented  to  the  veterinarian  for  clinical  examination.  This 
gives  rise  to  certain  difficulties  which,  in  the  main,  are  based. 


12  CLINICAL    DIAGNOSTICS. 

on  differences  in  anatomical  structure  and  physiological  func- 
tion of  the  organs  of  different  animals.  The  methods  of  ex- 
amination are  about  the  same  for  all  species.  One  who  has 
thoroughly  learned  the  fundamental  principles  underlying  the 
methods  for  the  proper  examination  of  a  horse  will  have  little 
trouble  in  adapting  them  to  other  animals.  However,  import- 
ant differences  in  this  respect  will  receive  due  consideration. 

A  further  considerable  difficulty  in  diagnostics,  for  the 
veterinarian,  is  his  inability  to  determine  the  subjective  feel- 
ing of  a  patient.  Still,  this  is  of  less  importance  than  the 
layman  usualh'  supposes.  On  the  other  hand. -to  compensate 
for  this,  we  are  in  a  position,  in  all  cases,  to  make  a  complete 
objective  examination  of  the  patient  in  any  direction.  In  this 
respect  we  have  an  advantage  over  the  physician  who  is  fre- 
quently denied  this  privilege  and  is,  besides,  liable  to  be  misled 
by  the  imagination,  whim,  shame  or  vanity  of  the  patient. 

A  diagnosis  consists  in  the  determination  of 

1.  The   symptoms   of  the   disease. 

2.  The    diseased    organ. 

3.  The     character     of     the     disease  —  its 
n  a  m  e  . 

A  Symptom  is  any  observable  deviation  from  the  nor- 
mal state  or  condition.  Anatomy  and  physiology  treat  of  the 
normal  conditions  and  functions ;  Symptomatology  treats  of 
morbid  conditions  and  of  perverted  functions. 

The  particular  object  of  a  clinical  examination  is  the  de- 
termination of  symptoms ;  it  must  therefore  include  the  exter- 
nal appearance  and  general  behavior  of  the  animal  as  well  as  a 
careful  inspection  of  every  accessible  organ.  To  avoid  mistakes 
or  overlooking  important  factors  we  must  conduct  this  exami- 
nation according  to  a  definite  plan. 

The  best  plan  to  follow  is  to  take  up  the  dift'erent  func- 
tional apparatus  in  their  physiological  order  and  complete  the 
examination  of  each  in  its  turn.  The  beginner  should  memo- 
rize the  scheme  and  follow  it  faithfully.     This  is  no  difficult 


DIAGNOSIS    OF    DISEASES.  13 

task  since  the  arrangement  is  a  physiological  and   therefore- 
natural  one. 

We  propose  the  following  order  of  procedure : 

I.     Anamnesis  (ascertaining  previous  history  of  case).. 
II.     Determining  the   Status  Praesens. 
A.     General    examination. 


1. 

2. 
3. 

Signalment  of  the  patient. 

Habitus. 

Skin. 

4. 
5. 

S 

Conjunctiva. 

Temperature. 

pecial     examinations 

B. 

6.  Circulatory  apparatus. 

7.  Respiratory  apparatus. 

8.  Digestive  apparatus. 

9.  Urinary  apparatus. 

10.  Sexual  apparatus. 

11.  Central   nervous   system. 

13.     Locomotion,    exercise    in    harness    or   under-  sad- 
dle, etc. 
C.    Specific    examinations. 

13.  Diagnostic   inoculations. 

14.  Examination  of  lymphatic  glands. 

15.  Examination  of  the  blood. 

The  anamnesis  should  be  procured  and  the  general  and. 
special  examination  should  be  made  at  least  once  during  the 
first  visit  to  the  patient.  If  the  diseased  organ  or  organs  have 
been  ascertained  they  must  be  carefully  re-examined  at  every 
subsequent  visit,  at  the  same  time  we  must  be  on  the  alert  for 
the  appearance  of  possible  symptoms  in  other  organs. 

The  specific  examinations  are  made  only  when  necessary 
for  clinching  the  diagnosis. 

The  determination  of  symptoms  is  at  times  difficult. 

Sometimes  external  influences  bring  about  certain  con- 
ditions of  the  healthy  body  which  must  not  be  interpreted  as 


14  CLINICAL    DIAGNOSTICS. 

symptoms  of  disease,  although  they  might,  under  other  cir- 
cumstances, be  such ;  e.  g.,  a  horse  refuses  its  feed — this  is  a 
frequent  occurrence  in  gastro-intestinal  affections  or  in  the 
course  of  severe  general  diseases,  but  it  may  also  be  due  to  an 
excitable  temperament  of  the  animal  or  to  the  fact  that  the  food 
in  itself  is  undesirable — spoiled,  mouldy.  Hence  the  practi- 
tioner must  always  endeavor  to  determine  the  cause  of  the 
symptoms,  whether  the  deviations  from  the  normal  are  reallv 
due  to  disease  or  to  external  conditions. 

The  importance  of  symptoms  depends  very  largely  upon 
the  conditions  under  which  they  appear. 

Rapid  respiratory  movements  may  be  due  to  a  disease  of 
the  respiratory  apparatus  or  to  some  other  affection ;  again, 
they  invariably  occur  after  bodily  exertions,  and  high  tempera- 
tures, even  when  the  animal  is  at  perfect  rest,  will  cause  the 
respiratory  movements  to  become  accelerated. 

To  avoid  confusing  symptoms  produced  by  muscular  ex- 
ercise, or  other  eft'orts  on  the  part  of  the  animal,  with  symp- 
toms of  disease,  the  patient  should  first  be  examined  in  a  state 
of  rest.  Furthermore,  all  conditions  that  could  possibly  influ- 
ence normal  physiological  processes  must  ever  be  taken  into 
consideration ;  for  example,  we  will  mention  age,  estral 
period,  pregnancy,  fright  on  part  of  the  animal,  etc. 

After  noting  the  symptoms  of  the  disease  we  come  to  the 
most  difficult  part  of  clinical  diagnostics,  viz : 

The  determination  of  the  organ  diseased.  There  are 
only  a  few  s\-mptoms  which  point  with  certainty  to  an  affec- 
tion of  a  definite  organ,  fewer  still  enable  us  to  recognize  the 
character  of  the  disease ;  these  latter  are  called  pathognomonic 
symptoms.  As  a  rule  all  symptoms  must  be  first  noted  and 
then  considered  as  a  whole,  always  bearing  in  mind  the  prin- 
ciples of  general  and  special  pathology. 

We  distinguish  diff'erent  kinds  of  symptoms: 

1.     Local  symptoms  belong  to  the  affected  organ  or  to 
the  disease  center. 


DIAGNOSIS    OF    DISEASES.  15 

2.  Direct  symptoms  are  due  to  the  fundamental  dis- 
ease or  morbid  process. 

3,  Indirect  or  accidental  symptoms  are  due  to  compli- 
cations of  the  fundamental  disease. 

To  determine  the  affected  organ  all  ascertained  symptoms 
are  carefully  reconsidered  in  the  order  in  which  they  were  de- 
termined. The  healthy  apparatus  are  for  the  time  being  dis- 
regarded, the  diseased  apparatus  are  given  special  considera- 
tion. 

A  variation  in  the  normal  functional  activity  of  an  organ 
does  not  in  itself  indicate  disease,  it  may  simply  be  a  compen- 
satory variation  (one  due  to  an  opposite  variation  in  a  similar 
organ)  due  to  the  primary  morbid  condition.  The  therapeut- 
ist's object  is  to  ascertain  the  primarily  affected 
organ,  bring  about  a  cure  in  this  and  secondarily  cause  the 
sympathetically  affected  organ  to  regain  its  natural  condition 
and  activity. 

To  discover  the  primarily  aff'ected  organ  requires  a 
knowledge  of  the  morbid  processes  that  take  place  in  each 
organ  and  of  the  direct,  indirect,  local  and  general  symptoms 
produced  by  them.  This  requirement  is  still  more  important 
for  the  final  aim  or  ultimate  purpose  of  diagnostics,  viz : 

The  recognition  of  the  disease  itself  according  to 
kind,  etiology,  i  n  t  e  n  s  i  t  v  and  duration. 
The  method  of  examination  of  each  organ  will  therefore  be 
followed  by  a  short  description  of  the  most  important  diseases 
of  each. 

One  who  has  not  yet  learned  from  his  school  training  or 
practical  experience,  to  appreciate  the  various  symptoms  which 
characterize  each  of  the  diseases  and  who  has  not  a  well- 
defined  mental  picture  of  the  appearance  of  each  of  the  dis- 
eases with  which  he  must  come  in  contact,  will  never  become 
a  good  diagnostician. 

Diagnosis  per  sc  has  a  different  value  depending  upon 
whether  it  is  made  for  a  scientific  or  wholly  practical  purpose. 


16  CLINICAL    DIAGNOSTICS. 

It  is  often  symptomatic  and  thus  merely  cloaks  our  ignor- 
ance ;  diabetes  insipidus,  colic,  for  instance.  The  purpose  of 
diagnosis  is  more  nearly  attained  when  it  includes  the  cause  of 
the  disease  (''etiological  diagnosis"),  which  is  of  value  even  if 
we  do  not  know  more  of  the  cause  than  that  it  is  some  specific 
infection  (influenza) .  An  anatomical  diagnosis  is  not 
conclusive  because  it  does  not  indicate  the  cause  (nasal  catarrh, 
bowel  catarrh).  An  ideal  diagnosis  would  be  "etiologico- 
anatomical"  (skin  glanders,  acarus  mange,  verminous  bron- 
chitis). A  correct  prognosis  and  rational  treatment  are  largely 
dependent  upon  a  knowledge  of  the  cause  and  morbid  changes 
of  the  disease. 

It  is  not  enough  to  diagnose  a  nodular,  itching  and  spread- 
ing eruption  of  the  skin,  we  must  also  determine  the  cause  or 
our  prognosis  and  treatment  cannot  be  correct  and  rational. 
Such  eruptions  are  due  to  various  causes  and  an  exact  knowl- 
edge of  them  is  an  important  item.  The  same  may  be  said  of 
affections  of  internal  organs. 

A  final  diagnosis  is  made  either  by  considering  the  deter- 
mined symptoms  directly  (direct  diagnosis)  or  by  a  process  of 
exclusion,  i.  e.,  we  review  in  our  mind  all  the  diseases  in  which 
the  symptoms  determined  occur,  or  in  which  some  of  these 
symptoms  occur,  and  then  we  exclude  those  diseases  in  the 
course  of  which,  if  present,  we  usually  observe  additional 
symptoms  {differential  diagnosis). 

Following  one  or  the  other  of  these  methods  usually 
suffices  to  make  a  diagnosis.  Not  infrequently,  however,  even 
the  experienced  practitioner  must  content  himself  with  limit- 
ing his  diagnosis  to  a  statement  of  the  general  character  of 
the  disease  and  reserve  the  privilege  of  expressing  his  final 
opinion  {special  diagnosis)  pending  further  observation  and 
developments.  This  is  particularly  the  case  in  the  first  out- 
breaks of  infectious  diseases  when  localized  changes  are  ab- 
sent. We  also  distinguish  between  a  definite,  a  probable,  and 
a  possible  diagnosis. 


DIAGNOSIS    OF    DISEASES.  17 

►  The  difficulties  encountered  in  diagnosing  internal  dis- 
eases vary  considerably ;  in  some  cases  a  good  anamnesis  suf- 
fices as  a  basis  for  making  a  definite  diagnosis :  epilepsy,  par- 
turient paresis.  In  other  cases  the  experienced  practitioner 
requires  but  a  glance  at  the  patient :  tetanus.  The  rule,  how- 
ever, is  never  to  make  a  diagnosis  until  a  thorough  and  careful 
examination  of  the  patient  has  been  made ;  but  here,  too,  care- 
fully cultivated  powers  of  observation  and  extensive  experience 
go  a  good  way.  To  acquire  either  of  these,  of  course,  requires 
continued  carefully  and  methodically  conducted  examinations. 
The  same  diseases  do  not  ahva.ys  present  the  same  set  of  symp- 
toms. Therefore,  the  more  often  a  disease  is  seen  by  the  prac- 
titioner, the  more  readily  will  he  recognize  it.  The  diagnos- 
tician should  be  like  the  experienced  botanist  who  recognizes 
a  plant  in  all  its  stages  of  vegetation.  There  will  alwavs 
remain  a  few  cases  the  symptoms  of  which  are  so  atypical  that 
an  exact  diagnosis  is  impossible. 

If  the  diagnosis  cannot  be  made  definite  in  every  respect, 
be  cautious  in  your  prognosis  and  therapeutics. 


I.    Anamnesis. 

Full  statements  on  the  part  of  the  owner  or  attendant, 
procured  by  cautious  questioning,  concerning  the  previous  con- 
dition of  the  patient,  the  beginning  and  previous  course  of  the 
'disease  {anamnesis)  are  of  great  importance  in  diagnostics,  in 
fact  there  are  some  diseases,  like  epilepsy,  for  example,  that 
can  as  a  rule  be  diagnosed  in  no  other  way  because  it  is  only 
in  exceptional  cases  that  we  have  an  opportunity  to  observe  a 
typical  epileptic  fit. 

As  far  as  the  veterinarian  is  concerned  the  anamnesis  is 
limited  to  the  observation  of  the  immediate  surroundings  of 
the  animal.  In  questioning  attendants  speak  to  them  in  a 
pleasant  tone  and  manner  and  use  words  and  expressions  with 
which  they  are  familiar ;  this  tends  to  infuse  confidence  and 
the  result  is  that  the  information  thus  obtained  will  be  more 
apt  to  be  reliable. 

Any  digression  in  the  testimony  of  informants  should  be 
listened  to  with  patience.  One  should  always  remember  that 
every  anamnesis,  from  whomsoever  it  be  obtained,  is  more  or 
less  colored  by  the  personal  conceptions  of  the  person  offering 
it.  This  is  quite  apart  from  intentional  misrepresentations, 
which  are  often  encountered. 

A  well  drawn  up  anamnesis  speaks?-  for  the  technical 
ability  of  the  veterinarian  as  well  as  for  his  knowledge  of  the 
etiology  of  the  diseases  of  o-ur  domestic  animals  which  are 
kept  under  the  most  variable  conditions. 

1.  How  long  has  the  animal  been  sick? 
We  may  learn  by  this  question  whether  the  disease  is  an  acute 
or  a  chronic  one,  and  perhaps  also  the  stage  of  development 


ANAMNESIS.  19 

which  the  disease  has  reached.  Frequently  the  time  given 
by  the  owner  or  attendant  is  much  shorter  than  the  actual 
duration  of  the  disease. 

2.  What  symptoms  has  the  animal  shown  ? 
In  the  beginning?  Later  on?  The  objective  observation  of 
the  owner  must  be  carefully  sifted  out  from  his  subjective 
interpretation  of  them. 

3.  What,  in  your  opinion,  could  be  the 
cause  of  the  disease?  We  cannot  search  for  the 
causes  until  we  know  the  symptoms. 

Where  and  under  what  conditions  did 
the  animal  get  sick?  Feed,  care,  etc.,  play  an  im- 
portant role  in  the  etiology  of  the  internal  diseases  of  ani- 
mals ;  therefore  the  veterinarian  must  be  informed  not  only 
as  to  the  kind  and  character  of  the  feed  but  also  as  to  soil 
conditions,  water,  etc.,  otherwise  he  cannot  intelligently  trace 
the  cause  of  the  disease. 

The  care  and  attention  animals  receive  wield  a  great  in- 
fluence upon  the  genesis  of  many  diseases.  It  is  rare  that  the 
veterinarian  can  obtain  from  the  attendants  reliable  data  con- 
cerning these.  He  should  judge  by  the  surroundings  in  this 
regard.  The  use  to  which  the  animal  was  put  when  the  dis- 
ease occurred  is  of  value  in  tracing  the  cause,  for  special  uses 
predispose  animals  to  certain  diseases. 

4.  A  number  of  animals  affected  by  the  same  disease 
always  points  to  a  common  cause,  viz. :  infection  or  intoxica- 
tion (poisonijig).  The  frequent  recurrence  of  a  disease  in  the 
same  stable  points  to  the  existence  of  a  permanent  cause. 

0.  It  is  of  especial  importance  for  the  veterinarian  to 
know  whether  any  previous  treatment  has  been  resorted  to 
and  what  effect  this  may  have  had.  Quacks  often  administer 
drenches  containing  solid  particles  in  suspension ;  these 
draughts,  instead  of  taking  their  usual  course,  may  enter  the 
trachea  and  thus  produce  a  fatal  pneumonia.  In  removing 
the  contents  of  the  rectum  its  wall  or  mucous  membrane  is 


20  CLINICAL    DIAGNOSTICS. 

also  often  injured.  In  such  cases  the  veterinarian  must  ex- 
ercise care  and  judgment  and  call  the  owner's  attention  to  anv 
existing  danger. 

Although  the  main  points  in  the  anamnesis  should  be  de- 
termined before  we  begin  our  objective  examination,  other 
questions  will  present  themselves  in  the  course  of  the  latter. 
Thus,  when  examining  the  respiratory  tract  we  may  inquire 
whether  the  animal  coughs,  and  when  examining  the  diges- 
tive apparatus  inquire  as  to  condition  of  bowels,  frequency 
of  evacuation,  etc.,  in  this  way  gradually  completing  our  exam- 
ination. 

The  value  of  a  good  anamnesis  consists  in  the  fact  that 
not  infrequently  it  is  sufficient  to  base  upon  it  a  definite  diag- 
nosis, i.  e.,  careful  objective  observations  of  the  layman  may 
in  some  instances  be  substituted  for  our  examination.  How- 
ever, the  veterinarian  must  always  be  cautious  in  complying 
with  the  oft  made  request  of  owners  to  treat  their  animals  in 
absentia.  Although  the  medicines  prescribed  under  such  con- 
ditions may  do  no  particular  harm,  rational  treatment  thus 
delayed  may  prove  to  be  a  positive  injury. 

Sometimes  the  veterinarian  is  misled  by  the  anamnesis. 
This  he  may  guard  against  by  making  a  careful  examination 
of  the  patient.  \Mien  the  anamnesis  does  not  conform  to  the 
results  of  the  examination,  it  should  be  accepted  with  caution ; 
where  the  opposite  is  true,  it  may  be  considered  reliable. 


II.  Determining  the  Status  Praesens. 

To  determine  pathological  phenomena  we  resort  to  all 
those  methods  which  throw  light  upon  the  physical  state  and 
functions  of  the  different  organs.  In  doing  this  we  should 
endeavor  to  follow  a  definite  plan  and  not  proceed  without 
system.  The  following  methods  are  generally  employed  and 
in  the  order  given : 

1.     Inspection. 

In  examining  the  different  parts  of  the  body  it  is  always 
best  that  we  first  regard  that  which  can  be  observed  with  the 
unaided  eye.  Students  are  apt  to  lay  their  hands  upon  the 
patient  too  soon.  Superficial  abnormalities  are  described  ac- 
cording to  their  seat,  size,  color  and  other  external  manifesta- 
tions ;  the  size  and  form  usually  being  compared  with  common 
objects,  unless  an  exact  description  is  desired  when  actual 
measurements  are  made. 

The  odor  emitted  by  the  se-  and  excretions  and  the  res- 
pirations is  also  noted. 

In  designating  the  seat  of  visible  pathological  conditions 
the  exact  anatomical  region  occupied  by  them  should  be  indi- 
cated. 

Regions  of  the  Body. 

I.    Head. 

A.     Face. 

1.  Nasal    region    with    dorsum    of    nose,    tip    of   nose, 

nasal   openings.      [Nostrils]. 

2.  Labial    region,    with    upper    and    lower    lips,   inter- 

labial  space  and  chin. 

3.  Buccal  region. 

4.  Infraorbital    region. 


22 


CLINICAL    DIAGNOSTICS. 


5.  Ocular  region. 

6.  Masseteric   region   with   maxillary  articulation. 

7.  Intermaxillary  space. 


II.     Neck. 


Fig.  1. 
B.     Forehead. 

8.  Frontal    region. 

9.  Occipital  region  with  forelock. 

10.     Temporal    region    with    the    temporal    fossa,    infra- 
temporal  groove   and   auricular   region.      [Ears]. 


III.     Chest. 


11.  Parotid  region,  which  merges  below  into  the  laryn- 

geal region. 

12.  Tracheal  region  with  jugular  groove,  at  the  lower 

end  of  which  is  the  supra-clavical  fossa. 

13.  Cervical    region   with    crest    and    mane. 

14.  Lateral    cervical   region,   sides   of  neck. 

15.  Withers  and  dorsal  region. 

16.  Lateral  pectoral  region  [sides  of  chest]  with  scap- 


DETERMINING    THE    STATUS    PRAESENS.  23 

ular  region,  cardiac  region,  costal  region. 

17.  Sternal  region. 

18.  Anterior   pectoral    region.      [Breast]. 

IV.  Abdomen. 

19.  Epigastric    region   with  xiphoid   space. 

20.  Mesogastric     region     with     umbilical     space,     iliac 

region    (flank   with   "hollow   of   flank")    and    the 
lumbar  region. 

21.  Hypogastric  region  with  pubic  and  inguinal  region. 

V.  Pelvis. 

The  diiiferent  divisions  of  the  pelvis  are  named  according  to 
their  anatomical  parts;  the  sacral  region  is  called  the  croup,  the 
external  angle  of  the  ilium  the  "hip,"  just  below  the  anus  the 
perineal  region;  the  anal  region,  pubic  region  and  inguinal  region. 

VI.  Extremities. 

The  different  parts  of  the  extremities  are  designated  according 
to  the  bones  and  joints  which  form  their  bases.  Anterior  limb: 
Shoulder,  point  of  shoulder,  arm,  elbow,  forearm,  "knee,"  cannon, 
fetlock  joint,  pastern,  coronet,  bulbs  of  heels,  hoof.  Posterior 
limb:     Thigh,  stifle,  leg,  hock,  hind  cannon,  etc. 

2.     Palpation. 

Palpation  consists  in  feeling  the  part  to  be  examined  with 
the  hand  or  finger  tips.  Its  object  is  to  gain  information 
through  the  sense  of  touch  as  to  the  consistency,  extent,  tem- 
perature and  sensitiveness  of  a  part,  and  permit  us  to  recog- 
nize abnormalities  which  do  not  lie  far  below  the  surface. 
Palpation  is  of  especial  importance  in  taking  the  pulse.  The 
abdominal  viscera  can  be  explored  (palpated)  through  the 
rectum  and  the  anatomical  position,  and  condition  of  the  con- 
tents determined. 

From  the  difference  in  consistency  of  the  parts  palpated, 
conclusions  as  to  their  physical  nature  may  be  drawn.  The 
following  peculiarities  may  be  distinguished  on  palpation: 

1.  A  part  is  doughy  when  it  feels  soft  and  accepts  finger 
imprints  which  it  retains  for  a  few  moments,  when  the. de- 
pressions are  again  filled.  Tissue  is  of  a  doughy  consistency 
when  infiltrated  with  serum:   (edema). 


"24  CLINICAL    DIAGNOSTICS. 

2.  A  part  is  firm  when  it  is  of  the  consistency  of  normal 
liver.  According  to  the  part's  resistance  to  the  touch  it  mav  be 
firm,  tendinous,  solid.  A  cellular  infiltration  of  tissues 
{phlegmon)  or  the  presence  of  neoplasms  made  up  of  cells, 
will  lend  to  a  part  a  firm  consistency  (connective  tissue). 

3.  A  part  is  hard  when  of  the  consistency  of  bone. 

4.  A  part  is  fiuctnating  when  it  is  soft,  elastic  and  undu- 
lates on  pressure.  Only  fluids  admit  of  such  a  rapid  trans- 
mission of  pressure  (pus,  blood,  lymph,  serum).  If  the 
tissue  surrounding  the  fluid  is  not  tense,  waves  are  seen  to 
pass  over  the  surface  of  the  swelling  (true  or  soft  fluctuations). 
Soft-elastic  (fat)  tissue  or  tissue  impregnated  with  a  quantity 
of  fluid  may  also  show  fluctuation  ;  this  undulating  consistency 
is  spoken  of  as  pseudo-fluctuation. 

5.  A  part  is  emphysematous  when  it  presents  a  pufl^\' 
swelling  which  crackles  and  shifts  on  palpation ;  it  is  due  to 
the  presence  of  air  or  gas  in  the  tissue  (emphysema). 

3.     Percussion. 

By  percussion  we  understand  striking  the  surface  of  the 
animal  body  so  that  the  parts  thus  set  in  vibration  emit  audi- 
ble sounds.  The  ''percussion-sound"  thus  produced  will  differ 
with  the  physical  condition  of  the  vibrating  parts,  and  these 
diflferences  are  so  well  marked  that  definite  conclusions  can  be 
•drawn  from  them. 

Methods  of  percussion.  Percussion  can  be  practiced 
without  the  use  of  instruments  [so-called  immediate  percus- 
sion] on  small  animals  or  large  animals  thin  in  flesh.  The 
index  or  middle  finger  of  the  left  hand  is  held  firmly  against 
the  part  to  be  percussed  and  struck  with  the  middle  finger  of 
the  right  hand.  The  striking  finger  should  be  held  somewhat 
curved  and  stiff.  The  advantage  of  immediate  percussion  lies 
in  the  facility  with  which  the  finger  may  be  placed  between 
the  ribs  and  amid  the  long  hair  of  some  dogs  and  the  wool 
of   sheep.      By   this   method   the   sense   of   hearing   is    further 


DETERMINING    THE    STATUS    PRAESENS.  25 

greatly  assisted  by  that  of  feeling.  For  the  larger  animals 
the  sounds  obtained  from  this  finger-to-finger  method  of  per- 
cussion are  not  definite  enough  for  practical  use. 

In  the  immediate  method  of  percussion,  however,  the 
sound  can  be  augmented  by  employing  the  percussion  hammer 
to  strike  the  finger  which  is  applied  to  the  part  (finger-hammer 
percussion). 

The  pleximeter  and  hammer  (plexor)  are  most  com- 
monly used  in  practice  [so-called  mediate  percussion]  as  they 
permit  not  only  of  gentle  percussion  but  the  part  to  be  ex- 
amined can  be  struck  a  heavy  blow  which  sets  deep-lying  parts 
into  vibration.  The  pleximeter  should  be  so  held  that  its  whole 
surface  is'  in  firm  contact  with  the  part  to  be  percussed.  In 
thin  animals  the  pleximeter  should  never  be  appHed  across  two 
ribs,  but  should  be  made  to  occupy  an  intercostal  space  that 
the  air  between  it  -and  the  body  does  not  modify  the  sound. 
The  force  with  which  we  use  the  hammer  depends  upon  the 
thickness  of  the  walls  of  the  part  percussed.  [In  fat  animals 
it  is  necessary  to.  use  more  force  than  in  lean  ones]. 

Usually  two  or  three  strokes,  not  too  close  together, 
suffice  to  bring  out  clearly  the  character  of  the  sound.  For 
comparison  it  is  advisable  to  percuss  corresponding  parts  on 
each  side  of  the  body. 

For  a  better  perception  of  the  percussion-sound  it  is  ad- 
visable to  select  a  suitable  place.  A  room  with  closed  doors 
is  the  best ;  in  rooms  filled  with  furniture,  or  out  of  doors  the 
application  of  percussion  is  never  satisfactory. 

As  a  rule  large  animals  are  percussed  while  standing, 
though  small  ones  may  be  placed  in  a  recumbent  position  upon 
a  table.  Although  gentle  animals  may  stand  quietly  during 
the  operation,  very  nervous  horses  or  stubborn  cows  some- 
times resist.  They  can  generally  be  quieted  by  speaking  to 
them  in  an  assuring  tone  and  by  omitting  all  rough  usage  of 
the  instruments.  Dogs  and  cats  may  be  held  by  their  owners 
•or  an  attendant. 


26 


CLIXICAL    DIAGXOSTICS. 


The  Qualities  of  Percussion-Sounds. 

A  body  can  only  then  produce  a  sound  when  it  has  lost 
its  equilibrium  and  vibrates  by  virtue  of  its  elasticitv.  Two 
principles  form  the  basis  of  percussion : 

1.  Solid,  airless  parts  of  the  body  give  forth  a  flat  sound 
of  short  duration  and  little  intensity.  Such  a  sound  is  called 
dull,  femoral  or  empty. 


Fig.  2.  Fig.  3.  Fig.  4. 

2.  If  an  air-containing  organ  is  set  in  vibration  it  pro- 
duces a  sound  of  considerable  intensity,  duration  and  tone, 
the  so-called  resonant  sound. 

The  clearness  of  the  sound  depends  upon  the  volume  of 
the  air-containing  organ  which  is  vibrating. 

a.  The  stronger  the  percussion  the  larger  is  the  part 
which  vibrates  and  the  fuller  the  sound  (Fig.  2). 

b.  The  thinner  the  over-lying  tissue  of  the  thoracic  wall 
the  more  lung  tissue  will  vibrate  and  the  fuller  the  sound 
(Fig.  3). 

c.  If  the  volume  of  the  air-containing  organ  is  small  in 
itself  then  the  sound  is  correspondingly  less  intensive  (Fig.  4). 

This  explains  the  varying  intensity  of  the  sound  over  dif- 
ferent portions  of  the  chest  wall  when  the  percussion  blows 
are  applied  with  equal  force.  The  resonant  sound  gradually 
merges  into  the  dull  femoral  as  we  approach  the  forward  and 
upper  portions. 


DETEI^MINING   THE   STATUS    PRATESENS.  37 

The  resonant  sound  may  be  subdivided  into: 

1.  The  tympanitic  sound,  which  approaches  a  musical 
tone. 

2.  The  full  sound  (puhiionary  resonance). 

The  tympanitic  and  full  sounds  are  both  resonant  in  char- 
acter, and  in  both  the  degree  of  clearness  can  vary  until  they 
become  identified  with  the  dull  sound.  The  intermediate 
stages  are  comparatively  duUcd  and  dull  tympanitic. 

Occurrence  of  the  Different  Qualities  of  Percussion- 
Sounds. 

According  to  the  above  classification  there  are  three  kinds 
of  percussion-sounds;  The  full  (pulmonary  resonant),  the 
tympanitic,  and  the  flat. 

1.  The  full  sound  is  found  over  normal  lung,  the  air  in 
the  alveoli,  and  the  lung  tissue,  and  thoracic  walls  vibrating. 
When  the  intestines  are  so  distended  with  gas  that  when  per- 
cussed their  walls  vibrate  with  their  contents,  a  full  sound  is 
emitted. 

2.  The  tympa)iiiic  percussion-sound  has  a  varied  origin. 
It  is  heard: 

2,.  Over  cavities  containing  air  which  communicate  with 
the  outside  world,  their  walls  being  either  firm 'or  yielding: 
trachea,  caverns  in  the  lung  communicating  with  bronchi. 
The  pitch  of  the  sound  depends  upon  the  size  of  the  cavern 
and  its  communicating  opening. 

b.  Over  enclosed  air-containing  cavities  the  walls  of 
which  are  little  distended,  hence  over  the  stomach  and  bowels. 

c.  Over  lung  tissue  the  tension  of  which  has  become 
diminished,      (atelectasis,  beginning  hepatization). 

3.  The  Hat  (femoral,  dull)  sound  is  heard  when  percuss- 
ing over  solid  tissues  which  do  not  contain  air.  As  the  most 
forcible  percussion  does  not  produce  vibrations  at  a  point  more 
than  10cm  below  the  surface,  dullness  can  be  noted  over  the 


28  CLINICAL    DIAGXOSTICS 

normal  lung  when  the  chest  walls  are  covered  with  heavy 
muscles,  fat,  or  edematous  swellings. 

The  sound  is  comparatively  dulled  when  air-containing 
parts  of  limited  dimensions  are  percussed  (borders  of  the  lung, 
and  under  thick  thoracic  wall)  or  if  small  airless  spaces  lie 
amid  those  containing  air  (nodular  thickenings  in  the  lung). 

During  the  application  of  percussion  we  should  note  the 
resistance  the  part  offers  to  the  hammer  or  striking  finger. 
[To  understand  what  is  meant  by  this  the  student  should 
strike  with  the  plexor  some  solid  object,  as  a  brick  wall,  and 
compare  it  with  the  feeling  experienced  when  the  human  chest 
is  percussed].  By  placing  the  index  finger  on  the  back  of  the 
hammer  the  resistance  can  be  better  appreciated.  From  the 
resistance  the  amount  of  vibration  that  can  be  induced  in  the 
underlying  parts  may  be  determined,  the  greater  the  former 
the  less  developed  the  latter.  For  this  reason  solid,  airless 
parts  like  muscle  give  a  shallow  percussion-sound  and  causes 
the  hammer  to  suffer  a  jar  when  they  are  struck. 

Tactile  Percussion. 

The  combination  of  palpation  and  percussion  is  called 
tactile  percussion.  Through  this  method  we  endeavor  to  ar- 
rive at  the  physical  condition  of  deep-lying  parts  by  stroking 
the  tissues  covering  them. 

METHOD.  The  wrist  and  fingers  should  be  held  slightly 
flexed  and  fixed.  The  parts  to  be  examined  should  be  pressed 
firmly  with  the  finger  tips,  exerting  an  interrupted  stroke. 
After  such  a  stroke  the  fingers  should  be  allowed  to  dwell  for 
a  moment  to  note  the  recoil  of  the  under-lying  tissue  the  con- 
sistency of  which  we  wish  to  determine.  In  practicing  this 
form  of  percussion  bear  in  mind  that  the  deeper  rather  than 
the  shallower  tissues  are  to  be  felt. 

Tactile  percussion  may  also  be  practiced  with  the  plexor 
and  pleximeter,  the  index  finger  being  rested  upon  the  back 


DETERMINING    THE    STATUS    PRAESENS.  29 

of  the  hammer.     It  is  usually  better,  however,  to  employ  ham- 
mer-to-finger or  finger-to-finger  percussion. 

The  thickness  of  the  over-lying  fat  or  muscular  layers 
does  not  seriously  interfere  in  this  form  of  percussion. 
Through  practice  we  learn  to  select  the  factors  of  importance 
to  form  an  opinion.  Deep-lying  diseased  conditions  do  not 
present  through  tactile  percussion  specific  symptoms,  but  we 
may  thus  obtain  valuable  information  in  regard  to  the  boun- 
daries and  consistency  of  otherwise  unavailable  organs  or 
parts.  Tactile  percussion  simply  supplements  and  completes 
palpation  and  ordinary  percussion. 

Determining  the  Boundaries  of  an  Organ  from  the 
Percussion-Sound. 

The  boundary  of  an  organ  can  be  determined  bv  percus- 
sion only  when  the  organ  lies  superficially  and  emits  a  percus- 
sion-sound which  differs  from  that  of  its  neighborhood.  For 
this  reason  the  boundary  of  the  heart  against  the  lung  or  the 
lung  against  the  bowels  may  be  defined  by  percussion. 

4.     Auscultation. 

By  auscultation,  applying  the  ear  to  a  part,  we  seek  to 
obtain  information,  through  the  sense  of  hearing,  as  to  the 
physical  state  or  condition  of  deep-lying  organs.  For  this 
reason  auscultation  is  practiced  upon  the  heart,  lungs  and 
gastro-intestinal  tract. 

In  human  medicine  auscultation  is  usually  practiced  with 
the  help  of  instruments  {mediate  auscultation),  the  so  called 
stethoscope,  etc.,  being  employed.  [In  veterinary  medicine, 
however,  the  use  of  such  instruments  is  very  limited,  the 
heavy  hair  coat  materially  interfering  with  and  so  modifying 
the  sounds  that  false  conclusions  may  be  drawn.  To  a  limited 
extent  the  phonendoscope  is  useful  in  auscultating  heart 
sounds,  but  the  hairs  over  the  cardiac  region  should  first  be 
thoroughly  moistened  or  oiled]. 

By  simply  applying  the  ear  firmly  to  the  part,  better  re- 


30  CLINICAL    DIAGNOSTICS. 

suits  can  be  obtained  than  by  the  use  of  instruments.  In  case 
the  skin  is  dirty,  bHstered.  or  the  animal  is  lousy,  a  towel  can 
be  placed  between  it  and  the  ear.  To  guard  against  being 
bitten  or  kicked  an  attendant  should  hold  the  patient  by  the 
head.  In  large  stables  containing  a  good  many  animals  the 
noises  they  produce  may  interfere  with  auscultation ;  if  it  is 
essential  to  diagnosis  or  prognosis,  the  patient  should  be  ex- 
amined in  some  quieter  place. 


A.  The  General  Part  of  the  Examination. 

I.     Signalment. 

By  the  Signalment  is  meant  a  description  of  the  patient 
for  identification  by  peculiar  marks  or  characteristics.  For 
forensic  purposes  and  special  cases  the  proper  taking  of  the 
signalment  is  of  great  importance.  It  is  further  of  some  value 
in  a  diagnostic  sense  and  is  sometimes  taken  into  consideration 
therapeutically. 

It  includes : 

I.  Kind  of  animal.  Many  diseases  are  peculiar  to  cer- 
tain genera  while  they  do  not  occur  in  others.  This  is  espe- 
cially true  of  the  infectious  diseases  as,  for  instance,  the  horse 
suffers  from  strangles,  and  glanders ;  the  ox  from  contagious 
pleuropneumonia  (lung  plague),  malignant  head  catarrh,  and 
swine  from  hog  cholera  and  swine  plague.  There  are  also 
special  sporadic  diseases  which  owe  their  origin  to  the  pecu- 
liar anatomical  or  physical  make-up  of  a  genus.  As  exam- 
ples, may  be  mentioned  traumatic  pericarditis  of  the  ox ;  rup- 
tures of  the  stomach  and  roaring  in  the  horse. 

II.  Sex.  Diseases  of  the  sexual  organs  are  not  com- 
mon in  animals,  but  sex  is  of  influence  in  the  appearance  of 
some  diseases.  In  stallions  inguinal  hernias  which  cause 
symptoms  simulating  colic  occur ;  mares  during  the  period 
of  heat  may  act  as  if  they  were  suffering  from  some  brain 
disease  (act  like  dummies)  or  may  balk  or  show  obstinacy 
when  at  work.  In  the  ox  urethral  calculi  are  not  uncommon. 
The  condition  of  pregnancy  is  as  of  great  importance  from 
the  diagnostic  as  from  the  therapeutical  standpoint,  because 
this  condition  may  induce  physiological  symptoms  that  would 
be  considered  pathological  in  non-pregnant  animals.     In  preg- 


32  CLINICAL    DIAGNOSTICS. 

nant  animals  caution  is  demanded  in  the  choice  of  drug's. 

III.  Color  and  white  markings.  For  diagnosis  the 
color  and  markings  arc  of  less  importance.  White  horses  fre- 
quently suffer  from  melanotic  tumors  that  are  either  super- 
ficial or  located  in  internal  organs.  White  areas  are  more  pre- 
disposed to  exanthemas,  sunburn  and.  "scratches." 

IV.  Age.  Many  diseases  -occur  either  exclusively  or 
generally  in  youth.  Rachitis,  diseases  of  the  navel,  strangles 
in  colts,  scours  in  calves  and  distemper  in  puppies  are  exam- 
ples. In  old  individuals  diseases  due  to  the  animal's  use  are 
more  frequent  as  are  also  chronic  diseases  of  organs  (dummies, 
heaves). 

The  age  is  also  of  influence  upon  the  prognosis  in  as  much 
as  healing,  all  things  else  being  equal,  is  more  to  be  hoped  for 
in  the  young  individual  than  in  the  old  one.  In  old  animals 
where  the  prognosis  is  a  doubtful  one  all  treatment  is  fre- 
quently omitted  on  economic  grounds. 

V.  Size.     Size  is  of  importance  in  posology  only. 

VI.  Breed.  In  well  bred  animals  the  reaction  against 
the  encroachment  of  disease  is  more  energetic  and  the  symp- 
toms are  more  pronounced.  Certain  breeds  are  more  able  to 
withstand  infectious  and  sporadic  diseases  than  others,  this 
must  be  considered  in  making  a  prognosis.  Breed  is  also 
taken  into  consideration  in  the  treatment  of  diseases.  Well 
bred,  fine  skinned,  sensitive  horses  yield  to  the  action  of  cer- 
tain drugs  more  readily  than  those  of  the  opposite  type.  This 
is  especially  true  where  outward  applications  (turpentine  blis- 
ters) are  to  be  made. 

2.     Habitus. 

By  the  term  habitus  we  mean  the  general  or  external  as- 
pect or  characteristic  appearance  of  the  patient,  which  is  de- 
termined by  its  physical  attitude,  condition,  conformation  and 
temperament.  It  offers  a  convenient  aid  in  diagnosis,  one 
that  can  be  readily  observed  and  that,  in  many  respects,  is  of 


GENERAL    PART    OF    EXAMINATION.  33 

great  importance.  Not  infrequently  a  diagnostic  conclusion 
in  a  clinical  case  is  reached  largely  through  the  impression 
the  patient  makes  upon  us  by  its  habitus. 

Obvious  physiological  abnormalities  are  sometimes  of 
themselves  an  index  to  the  character  of  the  disease.  How- 
ever, one  should  guard  against  reaching  hasty  conclusions 
from  the  first  impressions  of  the  patient,  to  the  neglect  of  a 
thorough   examination. 

I.  Attitude  of  the  patient.  Healthy  horses  as  a  rule 
remain  standing  during  the  day,  or  if  lying  down  they  imme- 
diately rise  to  their  feet  at  the  approach  of  a  stranger.  They 
will  frequently  lie  flat  on  the  side  with  feet  extended,  pro- 
vided the  halter  strap  is  long  enough  and  the  stall  of  suffi- 
cient  width. 

Healthy  cattle  (bovines)  lie  down  often  during  the  day, 
especially  just  after  feeding,  and  they  are  not  so  prone  to  rise 
when  approached.  They  seldom  lie  flat  on  the  side,  but  in 
sternal  decubitus  the  limbs  folded  under  them. 

Healthy  sheep  jump  up  when  approached  and  usually  run 
away. 

The  attitude  of  sick  animals  whether  standing  or  lying 
down  is  often  of  value  in  diagnosis. 

Standing  attitudes  assumed  during  disease.  The  head 
is  held  stifHy  and  extended  in  pharyngitis,  cerebro-spinal  men- 
ingitis, muscular  rheumatism,  malignant  head  catarrh  of  the 
ox,  and  in  acute  encephalitis  of  sheep  and  goats. 

\^ery  sick  animals  usually  hold  the  head  dozen,  and  as- 
sume a  relaxed,  languid  attitude,  the  ears  drooping;  horses, 
rest  their  feet  alternately. 

Cows  suffering  from  severe  vaginitis  stand  with  arched"' 
baek,  tail  held  high,  and  legs  spread  apart.  They  do  not. 
"stand  over"  readily  in  the  stable,  and  if  driven  stop  repeat- 
edly to  urinate. 

A  stiff,  quiet  attitude,  avoiding  moving  as  much  as  possi- 
ble, is  characteristic  of  very  painful  affections  in  the  chest  or 


34  CLINICAL    DIAGNOSTICS. 

abdominal  walls  (pleurodynia,  pleuritis,  peritonitis).  Stal- 
lions suffering  from  incarcerated  inguinal  hernia  and  oxen 
with  peritoneal  hernia  (gut  tie)  stand  with  the  hind  leg  of 
the  affected  side  held  backward  and  outward.  "" 

Unphysiological  attitudes.  Animals  afflicted  with  brain 
troubles  (acute  or  sub-acute  encephalitis,  dummies)  very 
often  assume  unnatural  attitudes.  Horses  stand  obliquely  in 
the  stall,  the  head  in  a  corner,  resting  against  the  wall  or 
sunk  under  the  feed  box.  The  limbs  are  drawn  well  up  under 
the  abdomen,  and  not  infrequently  one  leg  is  placed  in  a  very 
unphysiological  position,  perhaps  crossing  its  fellow  of  the 
opposite  side.  Dummies  stand  unusually  quiet  and  seem 
oblivious  of  their  surroundings.  They  move  without  energy, 
and  are  backed  with  the  utmost  difficulty.  (See  under  "Cen- 
tral Nervous  System,"  "Examination  of  Dummies"). 

Continued  standing  is  observed  in: 

a.  Old.  worn-out  horses. 

b.  Pneumonia  and  Pleuritis.  As  a  rule  if  the  animals 
lie  down  in  these  diseases  it  is  on  the  diseased  side,  and  for  the 
following  reasons :  because  the  slight  pressure  of  the  ground 
against  the  body  ameliorates  the  pain,  and  the  pleuritic  exudate 
(the  effusion  in  the  chest)  does  not  encroach  so  much  upon 
the  heart  and  the  still  healthy  lung.  The  respirations  are 
always  more  difficult  when  the  animal  is  lying  down.  [In 
peritonitis  resulting  from  castration  horses  very  commonly 
remain  standing;  when  forced  to  move  they  do  so  with  hind 
legs  held  in  abduction,  advancing  very  stiffly]. 

c.  Severe  Dyspnea.  The  head  is  held  extended  to  allow 
the  air  the  easiest  possible  access  to  the  lungs,  thus  facilitat- 
ing inspiration. 

d.  Horses  suffering  from  acute  diseases  of  the  brain. 

e.  Horses  suffering  from  Tetanus.  They  stand  with 
legs  braced  like  a  saw  horse,  the  head  somewhat  extended  and 
held  high,  the  back  held  rigid.  It  is  very  difficult  for  them 
to  step  sideways.    The  facial  expression  is  anxious,  the  mem- 


GENERAL     PART    OF    EXAMINATION.  35 

braua  nicfitans  appearing-  plainly  before  the  eye;  the  tail  is 
carried  high  and  stiff,  and  the  gait  inflexible  and  laborious. 

Restless  Standing.  Most  commonly  seen  in  horses  suft'er- 
ing  from  colic  and  acute  brain  diseases.  The  former  are  rest- 
less, lie  down,  roll,  and  get  right  up  again.  In  many  cases 
it  is  only  with  difficulty  that  they  can  be  kept  on  their  feet; 
when  down  it  may  be  equally  hard  to  drive  them  up.  They 
often  look  at  the  flanks,  paw,  strike  the  belly  with  the  hind 
feet,  switch  the  tail,  and  stretch  as  if  to  urinate  without  void- 
ing urine.     At  times  they  sit  up  like  a  dog. 

•Like  symptoms  but  of  shorter  duration  are  observed  in 
the  ox  suffering  from  invagination  of  the  intestines,  torsion  of 
the  uterus  in  cows  and  from  urethral  stones  and  peritoneal 
hernia  in  steers. 

Horses  with  acute  brain  disease  show  at  times  rabiform 
symptoms,  plunging,  rearing  and  breaking  loose.  When  not 
tied  they  keep  forging  ahead  or  continue  aimlessly  walking 
in  a  circle. 

Restless,  anxious  moving  about  is  seen  in  many  cases  of 
severe  dyspnea. 

GAIT.  A  labored,  slow,  exhausted,  wobbling  gait  is  noted 
m  severe  febrile  diseases.  It  is  especially  marked  in  influ- 
enza of  the  horse.  In  tetanus,  muscular  rheumatism  and 
purpura  hemorrhagica  the  gait  is  stiff.  Lameness  of  one  or 
more  limbs  is  seen  in  foot  and  mouth  disease  and  pyemia 
(pyemic  arthritis).  The  gait  is  unphysiological  in  acute  and 
chronic  hydrocephalus.  In  the  trotter  disease  of  sheep  the 
patient  does  not  walk  but  goes  at  a  stiff  trot.  The  crackling 
of  joints  is  heard  especially  in  equine  influenza. 

Lying  postures  assumed  during  Disease.  Animals 
found  lying  down  and  that  can  not  be  made  to  rise  should  be 
examined  very  carefully.  In  them  the  examination  is  always 
difficult.  We  should  first  try  to  drive  them  up  by  speaking 
to  them  in  a  sharp  tone  of  voice  and  assisting  them  by  me- 
•chanical  means.     It  is  important  to  determine  whether  they 


36 


CLINICAL    DIAGNOSTICS. 


are  really  unable  to  rise  or  whether  they  are  obstinate  and 
will  not  rise   (malingerers). 

If  the  animals  have  lain  for  a  long  time  on  one  side,  it  is 
advisable  to  turn  them  over  before  attempting  to  drive  them  up. 
The  same  should  be  done  when  after  a  fruitless  effort  to  get  an 
animal  onto  its  feet,  it  falls  back  again  to  the  ground  and  we  make 
a   second  attempt   to   make   it   stand. 


Fig.  5 — Horse  with  Azoturia. 


To  bring  recumbent  horses  to  their  feet  it  is  expedient,  after 
placing  them  on  the  sternum,  to  pass  the  end  of  a  long  halter  rope 
through  a  convenient  ring  in  the  wall,  and  keep  it  pulled  taut;  the 
hind  legs  should  be  doubled  under  the  body  in  a  natural  position 
and  the  fore  ones  extended  in  front.  By  speaking  to  the  animal, 
striking  it  over  the  ears  and  nose,  and  lifting  by  the  tail,  we  may 
assist  it  to  regain  its  feet.     When  this  method  fails,  a  sling  should 


GENERAL    PART    OF    EXAMINATION.  37 

be  placed  under  the  body  and  the  animal  raised  with  block  and 
tackle. 

The  ox  is  often  hard  to  induce  to  stand  up  after  it  has  been 
down  for  a  time.  It  may  be  able  to  get  up,  but  through  obstinacy 
will  not  do  so.  Whipping  and  beating  in  such  cases  is  usually  of 
no  avail;  yelling  in  the  animal's  ear,  setting  a  dog  on  it  or  tieing 
its  nose  shut  may  be  tried.  [By  placing  a  rope  around  the  body 
so  that  it  passes  beneath  the  brisket  in  front  and  the  ischii  behind, 
we  have  improvised  a  handle  by  which  several  persons  can  lift  the 
malingerer  to  its  feet.] 

•  Animals  may  be  unable  to  arise : 

a.  In  Tetanus.  Horses  suffering-  from  tetanus,  if 
down,  are  as  a  rule  unable  to  stand  up  without  help,  as  the 
spasmodic  contractions  of  the  extensors  of  the  limbs  prevent 
it.  When  recumbent,  the  upper  pair  of  legs  do  not  come  in 
contact  with  the  ground.  The  animals  are  very  restless  and 
bedewed  with  sweat. 

b.  In  Azoturia.  Horses  suffering  from  acute  azo- 
turia  make  vain  efforts  to  stand.  They  are  sometimes  only 
partially  successful,  the  fore  part  of  the  body  being  raised  and 
supported  by  the  front  legs,  but  the  hind  limbs  are  unable  to 
bear  their  share  of  the  weight,  breaking  down  under  it. 

c.  In  Spinal  paralysis  from  Fractures  of  Ver- 
tebrae. The  patients  lose  control  of  the  hind  parts  which  are 
no  longer  sensible  to  pain  [pin  pricks]'.  Sometimes,  however, 
reflex  spinal  convulsions  attend  "broken  back."  Dogs  with 
paralyzed  hind  parts  usually  sit  sideways,  the  legs  directed 
away  from  the  body. 

d.  Ante-and  Post-partum  Paresis.  Occurs 
in  cows  before  or  after  calving.  The  animals  seem  to  be  in 
comparatively  good  health,  have  a  good  appetite,  but  can  not 
regain  their  feet.  There  are  no  further  symptoms  of  disease 
or  injury.  They  often  lie  stretched  out  on  the  side,  [Prog- 
nosis is  favorable]. 

e.  Milk  Fever  (parturient  paresis).  The  cow  lies 
in  a  comatose  condition  on  the  left  side  as  if  in  profound  sleep, 
the  head  resting  against  the  right  chest.    If  the  head  be  lifted 


38 


CLINICAL    DIAGNOSTICS. 


it  drops  back  ag^ain  to  its  former  position  as  soon  as  released. 
Sensitiveness  and  temperature  of  the  whole  body  are  dimin- 
ished. 

f.  Cramp  of  the  Neck  (cerebro-spinal  meningi- 
tis). After  showing  symptoms  of  stifif.  wry  neck,  while  stand- 
ing, paralysis  follows.  The  patients  lie  flat  on  the  side  with 
the  head  drawn  backward,  the  body  convulsed  with  spasms. 

Old,  worn  out  horses  are  hard  to  get  upon  their  feet  once 
they  have  lain  or  fallen  down.  When  animals  are  suffering 
from  severe  pain  in  the  legs  and  feet  (founder)  or  when  lying 


Fig.  6.— Cow  with  Parturient  Paresis. 

on  an  injured  limb  (fracture),  they  can  as  a  rule  rise  only 
with  the  greatest  difficulty.  Colic  patients,  w^hen  down,  gen- 
erally do  not  get  up  promptl}-. 

Inspection  of  Herds.  In  examining  groups  or  entire 
herds  of  animals,  one  should  observe  the  behavior  of  each 
individual.  The  inspection  may  be  conducted  in  the  stable 
or  better  in  the  open,  without  undue  excitement,  and  any  ani- 
mal showing  symptoms  carefully  noted.  Sick  animals  are  rec- 
ognized by  their  attitude,  movements,  depressed  appearance, 
lack  of  appetite,  etc.  After  such  a  preliminary  survey  of  the 
group  or  herd  suspected  individuals  may  be  separately  scru- 
tinized. 

II.  Condition.  The  condition  of  the  animal  is  recog- 
nized principally  by  the  rotundity  and  fullness  of  development 


GENERAL    PART    OF    EXAMINATION.  39 

of  the  body.  Cold  blooded  horses  usually  have  well  rounded 
forms  because  the  muscles  are  of  large  size  and  surrounded 
by  well  developed  fat  deposits.  The  condition  as  to  flesh  is 
influenced  by  the  quantity  and  quality  of  the  food  and  the  use 
and  purpose  for  which  the  animal  is  intended  and  fed.  Con- 
tinued hard  work  reduces  the  fullness  of  the  body  outline, 
causing  the  conformation  to  appear  angular. 

When  the  digestive  tract  is  affected  with  disease,  whether 
local  or  general,  the  condition  of  the  animal  becomes  reduced. 
A  gradual  but  continual  loss  of  condition,  notwithstanding 
that  the  appetite  and  food  are  good,  always  points  to  chronic 
disease,  but  not  necessarily  to  disease  of  the  digestive  tract. 
When  the  digestive  tract  becomes  diseased  the  appetite  is 
imp.aired. 

Depending  upon  the  use  and  purpose  of  the  animal  we 
distinguish  the  following  kinds  of  condition:  Prime,  very 
good,  tolerably  good,  fair  and  bad.  A  gradual,  progressive 
general  emaciation  is  called  Cachexia.  Rapid  emaciation  ap- 
pears in  purpura  hemorrhagica  and  in  severe  infectious  dis- 
eases. Excessive  corpulency  (obesity)  is  common  in  bulls 
and  dogs ;  in  slaughterable  animals  it  is  desired. 

III.  Conformation.  It  is  advisable  to  classify  horses 
according  to  their  use  into  heavy  and  light  draft,  carriage  and 
saddle  horses.  The  classification  is  based  upon  the  animal's 
conformation.  To  judge  of  the  conformation  correctly  we 
should  take  into  consideration  the  depth  of  the  body,  breadth 
and  depth  of  chest,  curvature  of  the  ribs,  strength  and  angu- 
lation of  the  joints,  and  the  attitude  of  the  limbs  when  stand- 
ing naturally. 

Horses  with  flat,  small  chests  possess  poor  staying  quah- 
ties,  the  lungs  correlatively  being  small.  Horses  with  flat,  not 
well  sprung  ribs,  tucked  up  abdomens  and  long  legs,  are  as 
a  rule  poor  feeders.  As  such  animals  show  continually  poor 
appetites  for  food,  the  bowels  are  not  kept  well  filled,  hence 
the   body   appears   deficient   in   depth.      Hearty   horses,    good 


40  CLINICAL    DIAGNOSTICS. 

feeders,  show  on  the  other  hand,  better  developed  abdomens, 
the  bowels  being  distended  by  the  large  quantities  of  food 
they  contain.  The  more  voluminous  the  food,  the  greater  the 
circumference  of  the  belly.  [The  abdominal  circumference  is 
further  increased  in  pregnancy  and  in  diseases  causing  exu- 
dates to  accumulate  in  the  abdominal  cavity,  ascites]. 

Animals  with  curvature  of  the  spine,  abnormal  bending 
of  the  leg  bones  or  diffuse  enlargements  of  joints  suffer  or 
have  suffered  from  constitutional  bone  diseases  in  youth 
(rachitis).  Calves  with  broad,  beefy  hind  parts  and  wide 
loins  suffer  from  pelvic  distortion,  grow  slowly  and  should 
not  be  used  for  breeding  ("Doppellender"). 

IV.  Temperament.  By  temperament  we  mean  the 
mental  attitude  the  animal  assumes  toward  impressions  per- 
ceived through  the  medium  of  the  organs  of  sense.  An  ani- 
mal's knowledge  of  what  is  going  on  about  it  is  obtained 
through  the  instrumentality  of  the  bodily  senses  of  sight, 
hearing,  smell,  and  touch.  We  distinguish  between  a  livclv 
and  a  phlegmatic  temperament,  comparing  the  power  of  quick 
perception  with  its  opposite  slow  comprehension.  Too  much 
tendency  in  either  direction  will  affect  the  usefulness  of  an 
animal. 

Animals  of  fiery  disposition  often  show  temper  by  being 
stiibborii,  vicious,  balky,,  or  they  are  very  nervous,  anxious, 
easily  frightened,  which  reduces  their  economic  value.  Young 
animals,  especially  horses,  are  often  restless  and  like  to  play. 

Animals  of  a  very  phlegmatic  temperament  may  be  so 
slow  to  move  as  to  impair  their  usefulness. 

The  sort  of  temperament  possessed  by  an  animal  is  shown 
by  its  external  appearance.  The  countenance,  expression  of 
the  eye,  play  of  the  ears,  and  quickness  of  movement  form 
sources  from  which  the  temperament  and  disposition  may  be 
judged.  The  facial  expression  and  eye  give  information  as  to 
the  mental  condition. 

Blind  horses  are  often  scary ;  they  employ  the  sense  of 


GENERAL    PART    OF    EXAMINATION.  41 

liearing,  moving  the  ears  in  a  lively  manner  to  take  the  place 
of^  the  lost  sense  of  sight,  at  the  same  time  holding  the  head 
still.  This  may  cause  us  at  first  sight  to  suspect  that  the 
animal  is  suffering  from  a  brain  disease.  Old  horses  are  not 
so  sensitive  to  outside  impressions  as  colts.  Some  colts,  how- 
ever, are  little  observing  of  their  surroundings,  appearing  dull, 
stupid  and  lazy,  without  suffering  from  disease.  Great  fatigue 
produces  temporary  physical  and  mental  depression  also  tem- 
porary loss  of  appetite  in  phlegmatic  individuals. 

Febrile  diseases  affect  the  temperament,  making  the 
animal  affected  sluggish  in  its  movements.  In  animals  of  fiery 
temperament  this  is  not  so  noticeable. 

In  animals  suffering  from  severe,  serious  diseases,  the 
temperament  can  become  so  changed  that  vices,  such  as  crib- 
^bing,  biting,  kicking,  etc.,  are  no  longer  indulged  in.  The 
countenance  appears  blank,  expressionless,  staring,  eyes 
sunken,  locomotion  slow  and  unsteady.  A  few  hours  before 
the  fatal  termination  of  a  disease,  the  normal  tonus  of  the 
tissues  is  lost,  the  muscles  relax,  especially  those  of  the  face, 
forming  the  so-called  Hippocratic  countenance  (fades  Hip- 
pocratica),  one  of  the  symptoms  of  approaching  death. 

Diseases  Which  Are  Characterized  Particularly  by  Change 
in  Habitus. 

Colic  is  a  complex  of  symptoms  in  the  horse  characterized 
by  abdominal  pain  and  suppressed  peristalsis.  It  is  due  to  some 
affection  of  the  stomach  or  bowels.  For  the  symptoms  in  regard 
to  manner  in  which  pain  is  shown,  see  page  33.  Further  S5'mp- 
toms  are  sweating,  congested,  "muddy"  conjunctiva,  accelerated 
pulse,  dyspnea,  anorexia,  suppressed  peristalsis,  obstipation.  The 
cause  which  lies  at  the  bottom  of  these  clinical  phenomena  can 
be  determined  only  by  careful  examination  of  the  abdomen.  (See 
this.) 

Azoturia  is  an  acute  auto-intoxication  in  the  horse  character- 
ized principally  by  a  peculiar  severe  parenchymatous  inflammation 
and  paralysis  of  the  muscles  and  complicated  by  hemoglobinemia 
and  acute  nephritis.     It  appears  suddenly  under  symptoms  of  par- 


42 


CLINICAL    DIAGNOSTICS. 


alysis  of  one  or  both  hind  limbs,  inability  to  stand,  restlessness 
and  sweating.  Croup  muscles  tense,  hemoglobinemia,  hematuria. 
No  fever,  mind  clear,  dyspnea,  appetite  retained.  When  standing 
knuckle  in  joints  of  aflfected  limb;  make  ineflfectual  efforts  to  re- 
gain  feet;   hind  limbs  unable  to  support  body. 

Polyarthritis  (articular  rheumatism).  Febrile  infectious  dis- 
ease with  inflammation  of  usually  several  joints.  Without  appa- 
rent external  cause  there  appear  suddenly  hot  and  painful  swell- 
ings of  joints.  Patients  remain  lying;  high  temperature,  no  appe- 
tite, cease  ruminating.     Most  common  in  ox;  rare  in  horse. 

Muscular  rheumatism  (myositis  rheumatica).  Peculiar  in- 
flammation of  individual  muscles  or  groups  of  muscles.  Charac- 
terized by  wandering,  periodical  pains.     Mostly  confined   to  limbs 


Fig.  7.— Rachitic  Dog. 


and  back;  head  rarely  affected.  Temperature  not  high.  Not  in- 
frequently complicates  other  diseases,  especially  those  due  to 
refrigeration.      Most    common    in    horse,   dog  and    swine. 

Cerebro-spinal  meningitis  (cramp  of  the  neck).  Probably  in- 
fectious. Symptoms  vary.  Delirium,  spasms  of  the  muscles  of 
the  head,  neck  and  limbs.  High  fever;  dysphagia.  Patients  re- 
main lying  with   head   drawn  back    (opisthotonus). 

Parturient  paresis   (milk  fever).     See  pages  37,  38. 

Rachitis  and  osteomalacia.  Both  of  these  diseases  are  char- 
acterized  by  the  bones  being  deficient  in  lime   salts.     Such   bones 


GENERAL    PART    OF    EXAMINATION.  43 

possess  little  power  of  sustaining  weight,-  hence  they  suffer  change 
in  form  when  weight  of  the  body  must  be  borne  by  them. 

a.  Rachitis  appears  only  in  young  animals,  mostly  in  pigs 
and  puppies.  Pathologically  the  disease  may  be  considered  to  be 
a  remaining  softness  of  the  bones,  the  epiphyses  becoming  en- 
larged, the  diaphyses  bent.     An  upward  curvature  of  the  spine  ^^ 

is  called  kyphosis,  a  downward  ^^  lordosis,  a  lateral  I  scoliosis. 
Animals  suffering  from  rachitis  remain  lying  a  great  deal,  find 
trouble  in  regaining  their  feet,  and  locomotion  is  difficult. 

b.  Osteomalacia.  Fragility  of  the  bones  is  seen  only  in  adult 
animals  (cattle).  The  animals  lie  down  continually,  are  weak,  eat 
but  little,  and  become  thin  in  flesh.  The  bones  of  the  extremities 
become  brittle;  spontaneous  fractures,  decubitus,  and  death  ensue. 

3.    The  Skin. 

The  condition  of  the  skin  indicates  the  state  of  health. 
The  condition  of  tlie  skin  is  affected  not  only  in  local  diseases 
of  that  organ,  but  in  many  maladies  of  a  general  nature, 
involving  internal  viscera.  An  examination  of  the  integument, 
therefore,  is  of  importance  to  diagnosis.  The  skin  is  examined 
by  inspection  and  palpation;  in  local  diseases  the  microscope 
is  employed.  An  examination  of  the  skin  includes  the  fol- 
lowing : 

I.  Condition  of  the  hair  coat.  In  horses  and  cattle  in 
good  condition  the  hair  is  usually  short,  fine,  glossy,  and  lies 
smoothly.  Horses  running  on  pasture  or  kept  in  unsanitary 
stables,  show  a  long,  lusterless,  rough,  bristling,  hair  coat. 
If  the  condition  of  the  hair  coat  is  bad,  notwithstanding  good 
care  and  sheher,  it  may  be  assumed  that  the  animal  is  suf- 
fering from  ili  health.  The  appearance  of  the  hair  coat  is 
influenced  mostly  by  chronic  diseases.  Temporarily  the  hairs 
may  become  erect  when  the  animal  is  carrying  increased  tem- 
perature (chill)  or  from  the  effects  of  cold  air  or  water. 

In  long  haired  animals  the  hair  coat  should  lie  closely 
matted  and  the  hairs  have  the  same  general  direction. 

S  h  e  d  d  i  n  g  o  f  t  h  e  h  a  i  r.  In  horses  and  cattle  a  par- 
tial shedding  of  the  hair  occurs  normally  each  fall  and  spring.. 


44  CLINICAL    DIAGNOSTICS. 

In  the  fall  the  long,  soft  winter  coat  appears ;  this  is  shed  the 
following  spring.  [Animals  kept  blanketed  in  warm  stables 
retain  a  short  hair  coat  throughout  the  winter.]  Good  care 
and  proper  food  hasten  the  shedding  of  the  hair,  contrary  con- 
ditions tend  to  postpone  it.  When  the  winter  coat  is  retained 
during  the  summer  months,  it  indicates  usually  chronic  disease 
of  nutrition. 

W'hen  horses  which  have  been  poorly  kept  pass  into  good 
hands  and  receive  nourishing  food  and  good  attention,  an 
unusually  early  shedding  of  the  winter  coat  follows. 

Alopecia.  A  loss  of  hair  over  the  whole  or  a  large 
part  of  the  body  (alopecia)  sometimes  quickly  follows  the  re- 
covery of  an  animal  from  a  severe  infectious  disease  (con- 
tagious pleuropneumonia  of  the  horse).  A  gradual  loss  of 
coat  accompanies  chronic,  cachectic  diseases  in  sheep  and 
dogs.  In  chronic  diseases  affecting  nutrition  the  hairs  be- 
come loose,  and  may  be  easily  removed  by  pulling  or  rubbing. 
Horses  clipped  late  in  the  season  (November,  December)  grow 
short  winter  coats ;  when  these  are  shed  the  following  spring, 
the  skin  is  left  partially  denuded  of  hair,  giving  the  animal 
a  half-naked  appearance. 

Where  the  hairs  fall  out  in  patches,  and  lesions  are  found 
in  the  skin,  a  disease  of  the  integument  is  present. 

II.  Sweat  secretion.  The  skin  is  kept  continually 
moist  by  the  secretions  of  the  sweat  glands.  In  healthy  ani- 
mals at  rest  the  supply  of  secretion  is  just  sufficient  to  keep 
pace  with  the  loss  by  evaporation,  so  that  the  skin  does  not 
feel  wet  but  soft  and  pliable.  The  skin's  moisture  is  increased 
by  exercise,  high  atmospheric  temperatures  and  nervous  ex- 
citement. Sweating  does  not  become  visible  in  swine,  sheep, 
dogs,  and  cats. 

In  disease  a  more  or  less  profuse  outbreak  of 
sweat  {hyperidrosis)  appears : — 

1.  When  an  animal  is  much  weakened  from  acute  or 
chronic  disease. 


GENERAL     PART    OF    EXAMINATION.  45 

2.  In  severe  dyspnea,  where  it  is  compensatorv.  assist- 
ing the  lungs  to  throw  off  effete  matter;  stenosis  of  the 
anterior  respiratory  passages,  diffuse  pneumonias,  pulmonary 
emphysemas,  and  organic  heart  diseases. 

3.  In  painful  maladies :  founder,  colic,  enteritis. 

4.  In  diseases  painfully  affecting  the  muscles:  tetanus, 
epilepsy,  azoturia,  cerebro-spinal  meningitis. 

Normally,  perspiration  is  accompanied  by  a  hyperemia  of 
the  whole  skin.  If  this  congestion  is  absent,'  the  sweat  being 
excreted  upon  a  cold  skin  surface,  "cold  szvcat"  is  spoken  of, 
a  condition  to  be  judged  unfavorably  from  a  prognostic  stand- 
point. 

Local  sweating  (hypcridrosis  local  is),  or  sweat 
appearing  on  only  one  side  of  the  body  {hcmidrosis)  is  seen 
at  times  to  accompany  diseases  of  the  nervous  system. 

A  decrease  in  sweat  secretion  (hyphidrosis) 
can  be  so  well  developed  that  the  skin  feels  dry  (anidrosis). 
This  condition  can  best  be  appreciated  on  the  muzzle  of  the 
ox,  the  snout  of  the  hog,  or  the  nose-tip  of  the  dog.  These 
parts  in  healthy  animals  are  moist  and  nearly  cold.  During 
high  fever,  severe  diarrhea,  diabetes  insipidus  (polyuria), 
hyphidrosis  Is  a  common  attending  symptom.  In  severe  dis- 
eases where  life  is  threatened,  the  nose  feels  cold  and  dry. 

III.  Color  of  the  skin.  The  hair  and  pigment  prevent 
us  from  seeing  that  color  of  the  skin  which  is  caused  by  the 
blood  and  other  physiological  fluids  flowing  through  it.  With 
the  exception  of  the  horse,  nearly  all  white-coated  animals 
have  non-pigmented  skins.  [Horses  having  white  or  grey 
hair  coats  show  pigmented  skins,  the  white-born  (albino) 
horses  forming  an  exception.  The  parts  of  the  skin  which 
show  white  markings  (legs,  forehead)  are  as  a  rule  not 
colored]. 

Chronic  discharges  from  natural  openings  (the  eye.  nose, 
vulva)  cause  a  loss  of  pigment  from  the  portions  of 
the  skin  over  which  thev  flow. 


46  CLINICAL    DIAGNOSTICS. 

An  injection  (reddening)  of  the  skin  is  only  of 
■diagnostic  importance  when  not  produced  by  local  diseases  of 
the  integument.  A  diffuse  reddening  of  the  skin,  namely  of 
the  abdomen,  neck  and  between  the  thighs,  is  seen  in  swine 
erysipelas  (Rothlmif).  Red  spots,  often  angular  in  shape, 
accompanied  by  swelling  of  the  skin,  appearing  usually  over 
the  neck  and  along  the  back,  are  seen  in  urticaria  and  in  mild 
cases  of  erysipelas  in  swane. 

The  skin  becomes  bluish  red  (cyanotic)  when  the 
blood  is  heavily  charged  with  carbonic  acid  gas.  It  is  seen 
in  diseases  causing  swelling  of  the  glottis,  heart  diseases,  con- 
gestion and  edema  of  the  lungs,  and  in  overdriven  sheep  or 
swine  during  hot  weather. 

Yellow  (icteric)  discolorati6n  and  paleness  of  the 
skin  will  be  considered  under  "Examination  of  the  Conjunc- 
tiva."  (See  page  6U.) 

IV.  Condition  of  the  skin.  The  skin  of  a  healthy  ani- 
mal feels  pliable  and  clastic,  and  is  movable  upon  its  underly- 
ing tissues.  If  a  fold  of  it  be  drawn  out  between  the  fingers, 
it  soon  regains  its  former  place  when  released. 

Where  the  animal  is  poorly  nourished,  out  of  condition, 
or  emaciated  from  wasting  disease,  the  skin  feels  hard  and 
leather-like  (sclerosis,  induration).  [If  the  subcutis  has  also 
lost  its  elasticity,  and  the  skin  adheres  closely  to  the  under- 
lying parts,  and  cannot  readily  be  drawn  out  in  folds,  it 
causes  a  condition  that  is  commonly  termed  "hide  boundness"]. 

In  the  hide  bound  animal  the  e  p  i  d  e  r  m  i  s  is  dry  and 
tough,  the  outer  epidermal  layer  becomes  loose  and  may  be 
■easily  removed. 

The  skin  is  thus  coated  with  a  thick  layer  of  scales  and 
the  hair  filled  with  dandruff. 

The  exhalations  of  the  skin  sometimes  have  a 
penetrating  urinous  odor,  noted  not  infrequently  from  bladder 
rupture,  the  contents  of  the  organ  being  poured  into  the  ab- 


GENERAL    PART    OF    EXAMINATION.  47 

dominal  cavity.  In  the  ox  urethral  calculi  commonly  cause 
this  condition. 

V.  Swellings  in,  and  immediately  under,  the  skin. 
Diffuse  or  multiple  swellings  appearing  in  or  immediately 
under  the  skin  are  of  great  importance  as  an  aid  to  the  diag- 
nosis of  internal  diseases  which  they  accompany. 

Tumefactions  of  the  skin  attend  the  following  morbid 
processes : 

Edema  of  the  skin  and  subcutis  (anasarca) 
is  an  abnormal  accumulation  of  serum  in  the  connective  tissue. 
It  is  produced  by  a  transudation  of  fluid  (liquor  sanguinis) 
from  the  blood  into  the  intercellular  spaces.  The  lymph 
spaces  being  clogged  prevents  the  escape  of  the  fluid.  Ede- 
matous swelling  are  doughy  on  palpation  and  retain  finger  im- 
prints. 

Edema  can  be  due  to : 

a.  Continued  venous  congestion,  the  free  circulation  of 
the  blood  being  interrupted  (dropsy  from  stasis).  In  such 
cases  a  dropsical  swelling  appears  in  pendent  portions  of  the 
body,  removed  from  the  heart.  The  prepuce,  in  front  of  the 
mammae,  ventrally  along  the  abdomen  and  thorax,  hind  limbs, 
brisket  and  throat  are  the  favorite  seats  of  these  enlarge- 
ments which  are  neither  painful  nor  hot.  Any  morbid  condi- 
tion which  interferes  with  the  free  flow  of  the  blood  through 
the  veins,  leading  to  a  stagnation  in  these  vessels,  tends  always 
to  produce  edematous  swellings.  They  attend  organic  heart 
troubles,  chronic  pleuritis,  pericarditis,  and  traumatic  peri- 
carditis of  the  ox. 

b.  A  watery  condition  of  the  blood  (hydremia)  with 
which  occurs  an  abnormal  porosity  of  the  blood  vessels,  and  a 
subsequent  transudation  into  the  tissues.  The  edema  of 
hydremia  shows  neither  increased  warmth  nor  pain.  Drop- 
sies due  to  hydremia  are  noted  under  the  jaws  of  sheep 
afflicted  with  animal  parasites,  [the  lung  and  stomach  worms, 
Str.  contortus,  Str.  filaria;  liver  flukes.  Dist.  hcpaticum,  being 


48  CLINICAL    DIAGNOSTICS. 

the  most  common].  Leucemia  and  anemia  are  frequently- 
attended  \vith  skin  dropsies. 

c.  Inflammatory  edema  (collateral  edema)  also  pro- 
duces swellings  of  the  skin,  but  this  is  usually  local.  It  is 
characterized  by  pain  and  increased  warmth.  In  one  form 
of  anthrax  appears  a  circumscribed,  hot,  hard,  painful  tumor 
on  the  neck,  head,  or  body — the  malignant  carbuncle. 

In  some  of  the  infectious  diseases  a  more  or  less  diffuse, 
or  a  multiple  inflammatory  edema,  becomes  manifest ;  in  in- 
fluenza of  the  horse  the  eyelids,  scrotum  and  limbs  swell ;  in 
purpura  hemorrhagica  multiple,  later  diffuse  tumefactions 
occur  on  the  head,  prepuce,  lower  abdomen,  and  limbs.  [Leg 
swellings  in  purpura  are  characterized  by  their  abrupt,  bolster- 
like, termination].  A  local,  hot,  edematous  swelling  often 
betrays  the  presence  of  deep-lying  inflammation — pus,  and  is 
therefore  important  in  diagnosis.  In  s  t  r  a  n  g  1  e  s  of  horses 
suppuration  in  unavailable  lymph  glands  is  determined  by  the 
accompanying  edema  of  the  skin  in  the  region  of  the  throat; 
in  glanders  it  occurs  about  the  farcy  bud ;  in  traumatic 
peritonitis  of  cattle  a  hot,  doughy  swelling  appears  in 
the  hypochondrium. 

Emphysema  of  the  skin.  Emphysema  of  the 
skin  signifies  the  presence  of  air  in  the  subcutaneous  tissue. 
Such  swellings  crackle  on  palpation  and  are  usually  zn'cll  de- 
fined. The  contained  air  can  be  temporarily  displaced  by 
applying  pressure  to  parts  of  the  swelling,  but  as  soon  as  the 
pressure  is  released  the  space  caused  by  it  refills. 

Emphysema  originating  spont^aneously  is  infrequent.  It 
is  mostly  due  to  the  formation  of  gas  in  decomposing  blood 
extra vasates  or  retained  abscesses  {empli.  scpticum).  Spon- 
taneous emphysema  is  pathognomonic  of  symptomatic  anthrax, 
black  leg,  where  it  appears  upon  the  back,  neck,  and  muscular 
portions  of  the  legs. 

Emphysema  occurs  most  frequently  from  the  aspiration 
of  air   from   without  into  the   subcutis.     The  air  may   enter 


GENERAL    PART    OF    EXAMIXATIOX.  49 

through  a  wound  in  the  skin,  or  may  come  from  some  air- 
containing  internal  organ. 

In  the  first  case  the  air  is  sucked  or  pumped  into  the 
subcutis  through  skin  wounds  which  continually  shift  posi- 
tion during  locomotion.  Wounds  in  the  neighborhood  of  the 
elbow,  therefore,  produce  emphysema  of  the  shoulder  and 
neck.  It  is  a  common  practice  to  treat  atrophies  of  super- 
ficial muscles  ("sweeny")  by  inflating  the  overlying  skin  with 
air  artificially  introduced  by  a  bicycle  pump  or  pipe  stem]. 
In  the  second  case  the  emphysema  of  the  skin  has  its  origin 
from  an  internal  organ,  usually  the  lung,  the  alveoli  of  which 
are  ruptured  (interstitial  pulmonary  cmph\sema).  The 
course  followed  by  the  air  is  as  follows :  It  passes  from  the 
ruptured  alveoli  into  the  subpleural  connective  tissue,  making 
its  way  to  the  mediastinum,  between  which  folds  it  continues 
to  the  upper  part  of  the  thorax,  then  following  the  course 
of  the  trachea,  large  blood  vessels  and  esophagus,  it  escapes 
from  the  pectoral  cavity  through  its  anterior  aperture  into 
the  subcutaneous  and  intermuscular  tissues.  Rupture  of  the 
pulmonary  alveoli  may  result  from  a  destruction  of  the  lung 
tissue  by  pus  or  putrefaction  (gangrene).  Rib  fractures  in- 
volving the  lung,  great  intra-thoracic  pressure  from  violent 
coughing,  continued  bellowing,  forced  contraction  (straining) 
of  the  abdominal  muscles  in  bowel,  bladder  and  uterine  trou- 
bles, may  be  at  the  bottom  of  emphysema  of  the  integument. 

Sometimes  after  rumenotomy  or  trocaring,  gas  passes 
from  the  paunch  through  the  muscular  wound  into  the  sub- 
cutaneous tissue.  The  skin  wound  having  shifted  position, 
the  escape  of  the  gas  to  flie  surface  is  prevented,  hence  it 
collects  in  the  loose  connective  tissue  along  the  back. 

Diseases     of     the      Skin. 

The  following  terms  are  most  commonly  employed  to  denomi- 
nate  the   phenomena  of   skin  lesions: 

1.  Spots  (maculae)  are  well  circumscribed  abnormal  colora- 
tions of  the  skin. 


50  CLINICAL    DIAGNOSTICS. 

2.  Papules  {papulae)  are  small  cutaneous  elevations  of  solid 
consistency  varying  in  size  from  that  of  a  pin  head  to  that  of  a 
small   pea. 

3.  Vesicles  (vcsiculae)  are  elevations  of  the  outer  epidermal 
layer  due  to  the  accumulation  of  fluid  beneath.  They  vary  from 
the   size   of   a    millet-seed    to    that    of   a   pea. 

4.  Blisters    {bullae)    are   large   vesicles. 

5.  Pustules  {pustulae)  are  vesicles  containing  pus,  and  are 
therefore   colored  yellow. 

6.  Ulcers  {iilccra)  are  suppurating  wound  surfaces  which  re- 
sult  from   necrosis   of   tissue. 

7.  Scales  {squamae)  are  epidermic  lamellae  which  have  be- 
come detached  from  the  skin's  surface. 

8.  Scabs,  or  crusts,  are  dried  masses  of  exudate  upon  the  sur- 
face  of   the    integument. 

9.  Hives  (urticaria,  n-ettle  rash)  are  due  to  swellings  of  "the 
papillary  bodies,  producing  well-defined  evanescent  rounded  ele- 
vations, resembling  welts  raised  by  a  whip. 


I.     X  o  n  -  p  a  r  a  s  i  t  i  c    Skin    D 


s  e  a  s  e  s  . 


1.  Alopecia  (baldness)  is  a  loss  of  hair  due  to  some  disturb- 
ance in  the  skin's  nutrition.     It  may  not  be  attended  by  lesion. 

2.  Blood  sweating  {heinatidrosis)  is  the  spontaneous  appear- 
ance of  blood  upon  the  apparently  intact  surface  of  the  integument. 
It   is   peculiar   to   Hungarian   horses. 

3.  Prurigo  is  a  papular  eruption  accompanied  by  intense  itch- 
ing.    Biting  and  rubbing  induce  additional  lesions. 

4.  Summer  surfeit  {acne  simplex)  is  a  nodular  eruption  occur- 
ring usually  over  the  neck  and  shoulders,  leading  to  a  loss  of  hair. 
[It  is  seen  mostly  during  the  hot  months.  This  condition  is  often 
erroneously  attributed  to  some  "disorder  of  the  blood."  Its  chief 
cause  is  neglect  of  proper  grooming  and  care  of  the  skin  of  horses.] 

5.  Fagopyricm  is  an  acute,  diffuse,  itchy  inflammation  of  the 
non-pigmented  skin  of  the  head,  due  to  grazing  on  growing  buck- 
wheat in  bright  sunshine.  Brain  symptoms  sometimes  compli- 
cate the  disease. 

6.  Eczema.  In  a  general  way  the  term  eczema  designates  an 
exudative  dermatitis.  It  has  much  in  common  with  the  catarrhs 
of  mucous  membranes,  and  like  the  latter  can  pass  through  the 
varied  stages  of  erythema  with  desquamation,  papule,  vesicle  and 
pustule  formation  and  finally  squammae.  It  is  very  common  in 
>dogs,  appearing  along  the  back. 


GENERAL    PART    OF    EXAMINATION.  51 

7  Foot  eczema,  produced  by  potato  residue,  swill  and  brewer 
gram  feeding,  is  a  vesicular  eczema  occurring  on  the  hind  legs  of 
the  ox^  The  vesicles  rupture  soon  after  formation  and  their  con- 
tents dry  to  thick  yellow  scabs.  The  hair  of  the  affected  parts 
stands  erect  and  part  of  it  falls  out.  In  most  instances  the  eczema 
reaches  no  higher  up  the  legs  than  the  hock,  but  may  spread  to 
the  body  or  involve  the  anterior  limbs. 

11.     Skin     Diseases     Due     to     Animal      Parasites. 
The  common  skin  parasites  are: 

1.  Lice     or    Pediculidae     (Haematopinus     asini,     eurysternus 
urius,   etc.)  ' 

2.  Bird  lice  or  Mallophaga  (Trichodectes  equi,  scalaria    etc)* 

3.  Louse  flies  or  Hippoboscidae  (Hippobosca  equina,  Meloph- 
r.gus  ovis). 

4.  Ticks  or  Ixodidae   (Boophilus  bovi.^)    Texas  cattle  tick 

5.  Fleas  or  Siphonaptera  (Ceratopsyllus  serraticeps  of  dog 
Pulex  irmans   of  man).  ^' 

6.  Bird  ticks  or  Gamasidae  (Dermanyssus  avium,  D.  gallinae) 

7.  Mites  or  Acarina  (Chorioptes.  symbiotes,  horse,  ox,  goat, 
etc.).      (Psoroptes    communis,   horse,   ox,   sheep,   etc.).      (Sarcoptes' 

■equi,  cams,  suis,  cati.  etc.).     (Sarcoptes  mutans  of  fowl)      (Acarus 
folhculorum  or  Demodex  folliculorum,  var.  canis,  suis,  etc.). 

and  reShlP^Th^".-!!^"  '""^I"  ^^"0P°"  Pallidum,  is  remotely  related  to  the  trichodectes. 


52 


CLINICAL    DIAGNOSTICS. 


Fig.  8. 


Hacmatopinus  cqui. 
Blood-sucking    Louse. 


fig.  9, 


Trichodcctcs  cqui. 
Scale-eating    Louse. 


Fig.  10 


Figr.  11. 


Symbiotcs  bovis.  Psoroptcs  communis. 

Ventral  side.  Ventral  surface,  Egg  in  Oviduct. 


GEXERAL     PART    OF    EXAMINATION. 


53 


Mange  (scabies)  is  a  contagious  dermatitis  due  to  mites.  The 
principal    manges   are: 

a.  Symbiotic  mange  (foot  mange).  Favorite  seats:  in  the 
horse,  hind  limbs,  in  the  ox,  root  of  tail.  These  mites  live  on  the 
skin,  produce  loss  of  hair,  desquamation  of  epithelium,  and  intense 
pruritis,  causing  the  animal  to  stamp  and  kick  continually.  The 
mites  are  0.3 — 0.5  mm  long,  head  broad.    The  legs,  which  are  long, 

are  provided   at   their   ends   with   bell-shaped   suckers. 

b.  Sarcoptic  mange  of  fowls  (Dermatoryctes  mutans).  It 
.affects  the  legs,  causing  "Scaly  Feet."  The  lower,  naked  portions 
of  the  legs  become  coated  with  calcarious,  smearj^  or  honey-like, 
scab',  thick  deposits.  The  mites  are  0.2 — 0.5  mm  long,  legs 
short,  second  pair  well  removed  from  first.  U-shaped  chitinous 
shield   behind   head. 

c.  Psoroptic  mange.  Seen  in  the  horse,  sheep  and  ox.  Char- 
acterized by  great  desquamation,  the  appearance  of  vesicles  and 
papules,  the  hair  or  wool  agglutinated  by  crusts  of  dried  exudate; 
wool  becomes  tufted,  falls  out  in  patches,  intense  pruritis.  The 
psoroptes  is  the  largest  mange  mite,  0.4 — 0.7  mm  long;  head  long, 
pointed,  the  three-jointed  legs  provided  with  tulip-shaped  suckers. 

Fig.  12. 


Fig.  13. 


Sarcopfcs  scabici. 
Ventral   side. 


A  cams 
folliculorum. 


54 


CLINICAL    DIAGNOSTICS. 


d.  Sarcoptic  mange.  Seen  in  the  horse,  clog,  swine  and  cat, 
etc.  This  mite  burrows  tunnels  in  the  epidermis,  causes  nodules, 
crust  formation,  thickening  and  folding  of  the  skin,  pruritis.  Most 
difficult  mite  to  capture  for  microscopical  examination:  to  obtain 
material  for  examination  the  skin  should  be  scraped  to  bleeding. 
Sarcoptes  are  very  small,  turtle-shaped  mites  measuring  0.2 — ()..")  mm 
head  horse-shoe  shaped,  legs  short  and  stumpy. 

e.  Acarus  mange.  Most  common  in  dogs  and  swine,  ap- 
pearing principally  on  the  eyelids,  head,  extremities,  causing 
little  itching.  Skin  covered  with  scales,  small  pustules,  and  is 
thickened  and  folded.  In  the  squamous  form  circumscribed,  bald, 
bluish-red  areas  occur,  epidermis  mother-of-pearl-like,  scaly.  The 
parasite  is  vermiform,  0.2 — 0.3  mm  witli  a  long,  narrow,  jointed 
body,  the  anterior  portion  carrying  four  pairs  of  short,  three- 
jointed  feet,  at  the  end  of  each,  three  pointed  hooks.  Eggs  spindle- 
shaped. 

III.     Skin    Diseases    Due     to     Plant    Parasites. 

Ringworm  (Herpes  tonsurans)  is  induced  by  the  fungus  Trl- 
chopyton  tonsurans.  The  disease  is  characterized  by  the  app.-ar 
ance  of  small  round,  well-defined  hairless  patches.  The  smooth 
skin  is  covered  with  grey-colored,  asbes- 
tos-like crusts.  Spontaneous  healing  begins 
in  the  center  of  the  lesion,  extending 
toward  the  periphery  ("ringworm").  Vesi- 
cles rarely  appear.  Most  common  in  the 
ox.  In  the  crusts  and  more  especially  in 
the  hair  follicles  great  numbers  of  round 
or  ovoid,  light-refracting  spores  can  be 
seen  with  the  aid  of  the  microscope.  The 
spores  measure  4u.  Some  of  the  spores  are 
arranged  in  regular  order,  like  a  string  of 
beads,  others  are  disposed  in  irregular 
groups.  The  filaments,  which  may  be  sim- 
ple or  jointed,  show  little  tendency  to 
branching;  their  free  ends  are  rounded. 

Favus.  Rare,  but  appears  in  fowls  as 
so-called  "white  comb"  (Tinea  galli). 
Small  whitish-grey  spots  come  upon  the 
comb,  which  gradually  is  encrusted  by 
them.  In  mammals  thick,  depressed,  yel- 
lowish  brown   crusts  appear. 


Fig.  14. 


Trichophyton  tonsurans. 


GENERAL    PART    OF    EXAMINATION. 


55 


IV. 


Acute     E  X  a  n  t  li  e  m  a  s 


1.  Foot  and  mouth  disease  [said  not  to  occur  in  the  United 
States],  is  an  acute  infectious  disease  of  cloven-hoofed  animals, 
characterized  by  the  appearance  of  vesicles  upon  the  mucous 
membrane  of  the  mouth,  the  skin  of  the  coronet,  and  in  the  inter- 
digital  space.  Period  of  incubation  1  to  3  days.  The  disease  is 
attended  by  moderate  fever,  salivation,  diminished  appetite,  lame- 
ness,  recumbent   position.      The   vesicles   rupture,   leaving   erosions 


Fig.  15.— Urticaria. 


on  the  mucous  membranes,  and  dry  scabs  on  the  skin.     Complica- 
tions are  not  infrequent. 

2.  Sheep  pox  is  a  contagious  exanthema  running  an  acute 
course  and  having  a  typical  character.  Incubation  4  to  7  days; 
artificial  inoculation  shorter.  On  the  haired  portions  of  the  body, 
around  the  eyes,  nose,  mouth,  inner  surfaces  of  the  legs,  appear 
punctiform  reddenings  (pimples),  later  papules.     In  about  six  days 


56  CLINICAL    DIAGNOSTICS. 

the  papules  arc  covered  by  vesicles  filled  with  a  clear,  tenacious 
fluid  (eruptive  stage).  In  the  next  few  days  the  contents  of  the 
vesicles  become  turbid,  forming  pustules  (suppurative  stage);  then 
drying  of  the  pustules  to  a  solid  crust  (exsiccative  stage).  When 
the  crusts  fall  off  a  small  depressed  cicatrix  (pit)  remains.  During 
the  eruption  there  is  fever,  loss  of  appetite,  etc.  Course  about  3' 
weeks.      [Mortality  10  to  50%]. 

3.  Canadian  horse  pox.  A  contagious  pustulous  exanthema 
limited  usually  to  the  saddle  and  harness  rests.  Perio^d  of  incuba- 
tion 2  to  3  days.  A  few  isolated  prominences  of  the  size  of  a  half 
dollar  appear,  the  hair  on  them  is  erect  and  gathered  into  tufts. 
The  contents  of  the  bullae  becomes  purulent,  erupts,  dries  to  a 
brownish-yellow  solid  crust.  Caused  by  a  bacillus  measuring  2u, 
which   admits   of   staining  with   fuchsin. 

4.  Urticaria  (nettle  rash)  is  a  peracute  exanthema  which  is 
characterized  by  its  sudden  appearance.  Tumefactions  from  the 
size  of  a  pepper-corn  to  that  of  a  hand  or  saucer  come  upon  the 
neck,  head,  inner  surface  of  the  hind  limbs  and  on  the  body.  They 
are  prominent,  flat,  soft,  warm,  the  iiair  upon  tiiem  standing  erect; 
itching  is  rare.  Urticaria  of  swine  is  to  be  looked  upon  as  a  mild 
form    of    erysipelas.  % 

V.     G  e  n  e  r  a  1  D  i  s  e  a'  s  e  5     which     Affect     the     Skin. 

1.  Purpura  hemorrhagica  (morbus  maculosus)  is  an  acute  in- 
fectious disease  (an  intoxication)  characterized  by  the  appearance 
in  the  various  organs  of  the  body,  of  multiple  hemorrhagic  centers 
of  varied  size.  In  the  absence  of  complications,  the  disease  is 
unattended  by  fever.  On  the  mucous  membranes  of  the  nasal  pass- 
ages blood  spots  are  seen,  more  rarely  they  occur  in  the  conjunc- 
tiva and  buccal  mucous  membranes.  In  the  skin  and  subcutis  of 
the  lips,  cheeks,  and  nostrils,  appear  hard,  inflammatory,  edema- 
tous swellings  from  the  size  of  a  pigeon's  egg  to  that  of  a  hand 
(larger  by  confluence),  causing  the  head  of  the  horse  afflicted  to 
resemble  that  of  a  hippopotamus.  The  extremities  also  swell,  the 
swellings  terminating  abruptly  at  the  stifle  and  the  elbow.  There 
is  a  diffuse  edema  of  the  lower  abdomen;  hemorrhage  in  the 
internal  organs.  Breathing  is  labored  and  stentorious  from  the 
mechanical  obstruction  (swelling)  to  the  entrance  of  air  into  the 
upper  respiratory  passages.  There  is  difficulty  in  deglutition,  colic 
symptoms,  and  impaired  locomotion.  When  the  disease  has  existed 
for  several  days,  the  temperature  increases.  [Course  atypical,  6  to 
21    days.      Mortality    about    50%]. 


GENER.\L    PART    OF    EXAMINATION.      ,  57 

"VI.     Acute     Infectious     Diseases     which     Affect 
the       Skin. 

1.  Black  leg  (symptomatic  anthrax)  is  an  acute  infectious  dis- 
ease caused  bj-  the  entrance  of  a  germ  through  [the  digestive  tract 
or]  a  lesion  in  the  skin,  a  peculiar  emphysema  resulting.  On  the 
body,  shoulder,  neck,  upper  portions  of  the  extremities  (never  be- 
low the  knee  or  hock)  appear  swellings  which  are  at  first  hot 
and  painful,  but  later  cold,  painless,  emphysematous.  Incision 
causes  a  foamy,  fetid  fluid  to  flow  out  of  them.  Attending  symp- 
toms are  high  fever,  great  depression,  lameness,  dyspnea.  Mor- 
tality is   high.      [Prophylaxis,   protective  inoculation]. 

The  bacilli  of  black  leg  are  contained  in  the  discharges  from 
the  swellings.  They  measure  3 — 5u  long,  0.5 — 0.6u  broad.  One  end 
or  the  middle  is  enlarged  to  receive  an  ovoid  spore  which  it  bears. 
May   be   stained   by   Gram's   method. 

2.  Malignant  edema  appears  under  the  same  symptoms  as 
black  leg;  the  swellings  are  more  edematous  than  emphysematous. 

The  bacillus  of  malignant  edema  is  somewhat  like,  the  bacillus 
of  anthrax,  3. — 3.5u  long  and  l.lu  broad.  They  are  mostly 
united  at  their  ends  to  form  long  threads.  In  the  middle  of  some 
of  the  bacilli  or  at  the  ends  occur  spindle  or  drumstick-like  en- 
largements to  receive  the  ovoid  spore.  The  spore  does  not  accept 
ordinary   stains. 

3.  Bovine  pest  (Rind  und  Wildseuche)  is  produced  by  the 
bacterium  of  hemorrhagic  septicemia  and  appears  in  the  exan- 
thematous,  pectoral,  or  intestinal  forms.  On  the  head  and  rfeck 
appear  large  inflammatory  edematous  swellings,  which  spread  to 
the  mucous  membranes  of  the  mouth  and  throat.  The  pectoral 
form  is  attended  by  a  croupous-hemorrhagic  pneumonia  with  pleu- 
ritis,  and  the  intestinal  form  with  hemorrhagic  enteritis  and  swell- 
ing of  the  intestinal  viscera.  The  Bacterium  septicemiac  haemor- 
rhagicae,  like  that  of  contagious  pneumonia*,  of  swine  and  of 
chicken  cholera,  is  0.6u  long,  0.3u  broad,  oval,  stains  only  at  the 
ends,   an   unstained   belt   remaining. 

4.   Examination   of   the   Conjunctiva. 

The  exainination  of  the  conjunctiva  serves  to  determine 
the  quantity  and  condition  of  the  circulating  blood. 

Method.  Avoid  all  rough  and  hasty  manipulations.  Before 
grasping  the  eyelid  gain  the  animal's  confidence  by  arranging  the 
foretop  and  gently  stroking  the  forehead.     The  right  evelid  should 


58 


CLINICAL    DIAGNOSTICS. 


be  lifted  with  the  fingers  of  the  left  hand,  the  left  one  with  those 
of  the  right  hand.  By  means  of  the  tliumb  the  upper  eyelid  is 
raised,  the  index  finger  then  replaces  the  thumb,  and  by  gently 
pressing  the  everted  lid  inwardly,  the  mucous  membrane  of  the 
upper  eyelid  and  the  membrana  nictitans  become  visible.  The 
thumb,  which  is  now  free,  draws  the  lower  lid  downward.  The 
other  three  fingers  may  be  rested  against  the  zygomatic  arch, 
steadying   the   hand.      (See   figure   16). 


V 


^W 


^^ 


1 


Fig.  16. 
In  the  ox  a  good  view   of  the   scleral   conjunctiva   may  be   ob- 
tained by  simply  taking  hold  of  a  horn  and  the  nose,  and  drawing 
the  head   to  one   side. 

If  we  wish  to  arrive  at  the  condition  of  the  blood  from 
an  examination  of  the  mucous  membrane  of  tlie  eye,  that 
organ  must  be  free  from  local  irritation.  Severe  exercise,, 
and  high  atmospheric  temperature  cause  a  healthy  mucous 
membrane  to  appear  very  red  from  physiological  congestion ; 
local  inflammation  also  produces  congestions. 

A  careful  coinparison  of  both  eyes  will  enable  us  to  deter- 
mine the  presence  of  local  inflammation.     In  healthy  animals 


GENERAL    PART    OF    EXAMINATION.  59 

the  color  of  the  conjunctiva  is  pale-roseate;  in  the  ox  paler 
than  in  other  animals.  A  few  blood  vessels  are  always  visi- 
ble. In  the  conjunctiva,  the  boundar}^  between  normal  and 
diseased  conditions  is  not  sharply  drawn,  hence  practice  alone 
makes  one  capable  of  giving  a  reliable  judgment. 

I.  Discharge  from  eyelids.  Although  mostly  due  to 
local  diseases,  some  of  the  infectious  diseases  have  discharges 
from  the  eyelids  constantly  present.  The  discharge  is  either 
bilateral  (from  both  sides)  or  unilateral  (from  one  side  only). 
Bilateral  discharges  are  seen  in :  malignant  head  catarrh  ( with 
keratitis),  bovine  pest  (no  keratitis  present),  dog  distemper, 
fowl  cholera,  influenza.  (Swelling  shuts  off  the  tear  ducts). 
Unilateral  discharges  occur :  in  continued  clu-onic  nasal 
catarrh,  a  symptom  of  glanders,  chronic  nasal  or  sinus  catarrh. 
[In  all  animals  showing  unilateral  discharge  from  the  eyelids, 
especially  when  the  discharge  is  copious,  a  careful  examination 
for  foreign  bodies  should  be  made]. 

II.  Color.  The  color  of  the  conjunctiva  is  due  to  the 
quantity  of  blood  circulating  in  the  blood  vessels  of  the  organ 
and  the  amount  of  hemoglobin  contained  in  the  blood  cor- 
puscles. A  pale,  anemic  color  shows  that  the  animal  is  either 
deficient  in  blood  or  that  the  blood  does  not  contain  its  nor- 
mal quota  of  red  corpuscles.  The  color  varies  from  reddish- 
white  to.  greyish-white  or  white. 

Paleness  occurs  suddenly : 

1.  Following  great  loss  of  blood,  internal  hemorrhages- 
(liver,  heart,  large  blood  vessels,  etc.). 

2.  In  congestion  of  blood  in  the  intestines  (embolism  of 
intestinal  arteries,  displacement  or  torsions  of  the  bowels). 

Paleness  appears  as  a  chronic  condition : 

3.  In  constitutional  diseases  of  the  blood-making  organs 
(leucemia,  hydremia). 

4.  In  all  chronic  diseases  which  lead  to  anemia  or 
hydremia,  glanders,  tuberculosis,  distomatosis  (liver  flukes) 
and  parasitic  diseases  of  the  stomach  and  lungs  of  sheep. 


"60  CLINICAL    DLVGNOSTICS. 

J^cnous  en^or(!;eincnt  does  not  come  from  plethora.  It 
may  he  ramiform,  diffuse  or  punctiform,  and  varies  in  color 
from  a  brick  red  to  dark  red  or  muddy  (cyanotic). 

Raiiiifonn  coui^cstion   from  disease  occurs : 

1.  In  congestion  of  the  head  due  to  hyperemia  of  the 
brain,  encephalitis.  The  blood  vessels  are  plainly  marked  in 
tlie  diffusely  reddened  conjunctiva. 

2.  When  the  return  of  the  venous  blood  from  the  head 
is  retarded.  Characterized  by  distension  of  the  veins.  Occurs 
in  organic  heart  diseases,  heart's  weakness,  pulmonary  em- 
physema. 

A  diffuse,  faded  bluish-red  discoloration  of  the  conjunc- 
tiva is  found  in  conditions  leading  to  an  overcharging  of  the 
blood  with  CO2.  It  is  seen  in  febrile  diseases  (infectious 
diseases),  and  wherever  air  is  prevented  from  passing  freely 
into  the  lungs :  diseases  of  the  respiratory  tract,  respiratory 
muscles,  or  heart. 

Inflammation  of  tlie  mucous  membrane  of  the  gastro- 
intestinal tract  in  the  course  of  colic,  produces  a  cyanotic  con- 
junctiva; if  fever  appears  it  becomes  ramiform   (a  bad  sign). 

Yellow  (icteric)  discoloration  {jaundice) 
is  best  observed  on  the  scleral  conjunctiva.  It  is  not  noticeable 
by  artificial  light.  If  the  conjunctiva  is  pale  (bloodless),  the 
yellow  can  be  more  readily  appreciated.  The  shades  vary 
from  a  mere  trace  of  yellow  to  pronounced  lemon  yellow ;  in 
most  cases  combined  with  congestion.  The  icteric  discolora- 
tion is  due  to  the  abnormal  amount  of  bile  coloring  matter 
found  free  in  the  blood  serum. 

According  to  the  origin  of  the  yellow  coloring  matter  we 
distinguish : 

1.  Hematogenous  icterus  originates  from  a  dissolution 
of  the  red  blood  corpuscles,  the  coloring  matter  becoming  set 
free  and  mixing  with  the  blood  serum.  Hematogenous  icterus 
is  really  a  hemoglobinemia.  The  dissolved  blood  coloring 
matter  (the  methemoglobin)  is  not  changed  to  Ijib.-  pigment 


GENERAL     PART    OF    EXAMINATION.  61 

in  the  blood,  but  in  the  Hver.  If  this  organ  is  able  to  convert 
all  of  the  coloring  matter  to  bile  and  excrete  it  through  the 
bile  ducts,  the  urine  will  contain  no  bile,  but  the  feces  will 
become  stained  by  it  (hypcrcholia)  and  assume  a  dark  color. 
It  may  happen,  however,  that  the  bile  becomes  so  thick  that 
it  congests  the  smaller  bile  ducts,  is  reabsorbed  and  stains  the 
urine. 

Hematogenous  icterus  is  seen  in  influenza  of  the  horse, 
azoturia,  pyemia,  septicemia  [Texas  fever],  and  in  certain 
cases  of  poisoning,  especially  after  prolonged  chloroform  nar- 
cosis. 

2.  Hepatogenous  icterus  is  due  to  the  free  flow  of  bile 
from  the  liver  becoming  retarded  (biliary  stasis)  and  its  pass- 
ing over  into  the  blood  (cholemia)  via  lymph  vessels  and  tho- 
racic duct.  The  obstruction  may  haye  its  seat  in  the  biliary 
capillaries  or  larger  ducts,  and  often  at  the  ductus  choledochus 
in  the  bowel.  Hepatogenous  icterus  is  characterized  by  the 
appearance  of  bile  pigments  in  the  urine  while  the  feces,  con- 
taining less  than  normal,  are  of  too  light  a  color. 

Hepatogenous  icterus  is  seen  in  duodenal  catarrhs  with 
swelling  and  mucous  obstruction  of  the  ductus  choledochus, 
tumors,  parasites  (ascarides)  and  concretions  which  block 
the  bile  flow.  In  lupinosis  and  phosphorous  poisoning  a  swell- 
ing of  the  ducts  and  parenchyma  of  the  liver  occurs  leading  to 
the  collection  and  absorption  of  bile. 

Malignant  icterus  {icterus  graz'is)  has  associated  with  it 
mental  depression  and  slow  heart's  action  due  to  the  effect  of 
the  cholic  and  other  acids  contained  in  bile. 

III.  Swelling.  Swellings  of  the  conjunctiva  usually 
are  diffuse  and  may  occur  in  both  eyes.  They  are  due  to  a 
serous  infiltration  of  the  mucosa  and  submucosa.  If  of  an 
inflammatory  character  they  are  hot  and  painful.  This  con- 
dition finds  its  best  development  in  influenza  of  the  horse, 
the  greatly  swollen,  glassy  mucous  membrane  protruding  from 
between  the  half-closed  lids.     It  is  seen  further  in  contagious 


•G2  CLINICAL    DL\GXOSTICS. 

pleuropneumonia  of  the  horse,  purpura  hemorrhagica,  ma- 
hgnant  head  catarrh  of  the  ox,  bovine  pest,  anthrax,  dog  dis- 
temper, chicken  diphtheritis. 

The  swelhng  may  be  due  to  hydremia,  as  in  primary 
anemia  and  in  cachectic  diseases  of  sheep :  Hver  fluke  disease, 
huig  and  stomach  worm  plague. 

In  the  course  of  chronic  diseases  of  the  stomach  and  in- 
testines a  slight  swelling  of  the  conjunctiva,  attended  with  a 
washed-muddy   and   sometimes   icteric   discoloration,   appears. 

The  conjunctiva  may  be  drier  than  normal  in  severe  feb- 
rile diseases  and  bad  colics. 

5.     Bodily  Temperature. 

The  internal  temperature  of  the  body  is  maintained,  with 
slight  variation,  at  a  definite  elevation  by  means  of  an  es- 
pecial regulating  apparatus.  The  production  of  heat  in  the 
bodv  and  the  loss  of  heat  from  the  body  are  kept  equal.  If 
the  temperature  varies  from  the -normal,  and  this  variation  be 
preserved  for  a  time,  a  disturbance  due  to  disease  is  afifecting 
the  regulatory  apparatus. 

The  determination  of  the  internal  temperature  is  of  great 
importance  in  the  diagnosis  of  disease,  for  each  deviation 
from  the  normal  is  to  be  considered  a  symptom  of  considera- 
ble moment.  In  all  diseases  affecting  internal  organs,  the 
measuring  of  the  temperature  is  imperative. 

Method  of  examination.  Thermometry.  Formerly  the 
temperature  was  approximated  by  laying  the  hand  upon  dif- 
ferent parts  of  the  body,  namely  the  nose,  ears,  horns,  extrem- 
ities, or  by  inserting  the  fingers  into  the  mouth.  Such  methods 
require  long  practice  before  a  reliable  estimate  can  be  ob- 
tained, and  they  are  always  deceptive.  Only  in  exceptional 
cases  are  they  now  in  vogue.  The  temperature  is  most  ac- 
curately measured  with  a  thermometer,  graduated  in  degrees 
and  tenths  of  a  degree.  [Except  in  America,  England  and 
perhaps  one  other  country  the  Celsius  (centigrade)  thermom- 
eter is  in  common  use.     It  is  graduated  into  100  degrees,  and 


GENERAL    PART    OF    EXAMINATION.  63 

these  subdivided  into  tenths  of  a  degree.  In  this  country  the 
Fahrenheit  thermometer  is  generally  used.  It  is  graduated 
into  212  degrees,  each  degree  being  subdivided  into  fifths. 
Our  preference  for  this  latter  instrument  is  largely  tradi- 
tional, and  it  is  being  displaced  by  the  centigrade,  which  is 
now  almost  universally  employed  in  scientific  work. 

The  following  simple  formula  will  indicate  how  readilv 
the  Celsius  scale  may  be  converted  into  the  Fahrenheit  scale 
and  vice  versa: 

Fahrenheit  =  9-5  C  +  32. 
Celsius  =  5-9  (F  -  32)]. 

For  veterinary  practice  a  maximum  thermometer  should 
be  used,  preferably  a  tested  or  compared  instrument.  The 
thermometer  should  be  inserted  full  length  into  the  rectum, 
which  gives  the  best  results,  though  in  exceptional  cases  the 
vagina  is  chosen. 

We  should,  of  course,  guard  against  being  kicked  by  the 
animal,  and  exercise  care  that  the  instrument  does  not  break 
and  injure  the  mucous  membrane.  Before  introducing  the 
thermometer,  the  column  of  mercury  should  be  shaken  down. 
The  use  of  water,  saliva  or  oil  facilitates  insertion.  We 
should  allow  the  instrument  to  remain  in  the  rectum  from 
three  to  five  minutes. 

Taking  the  bodily  temperature  once  daily  is  of  great 
value  during  the  course  of  an  internal  disease ;  in  important 
cases  the  temperature  should  be  registered  twice  a  day  (8  a.  m. 
and  5  p.  m.).  After  diagnostic  inoculations  (tuberculin, 
mallein),  especially  during  the  critical  period,  the  temperature 
should  be  recorded  at  least  every  two  hours.  Thermometry 
is  of  great  diagnostic  importance  during  an  outbreak  of  an  in- 
fectious disease,  the  elevation  in  temperature  being  often  the 
first  symptom  shown.  By  taking  the  temperature 
once  daily  (best  at  evening),  the  infected 
animals  may  be  determined  before  further 
symptoms   of   disease    develop;     [influenza, 


64  CLINICAL    DIAGNOSTICS. 

contagious   pleuropneumonia,   swine   plague 
or   hog   cholera,    Texas    fever]. 

I.  The  Normal  Temperature.  The  normal  tempera- 
tures of  the  different  animals  are  as  follows : 

Horse   .  .37.5— 38.5°  C.      [   99.5— 101.3°  F.] 
Ox    ....38.0—39.0°"       [100.4— 102.-?°   ■•  ] 
Sheep   ..39.0^0.5°  "       [102.2—104.9°   "] 
Goat   ...39.0 — 10.5°  "       [102.2—104.9°   "] 
Hog    ...38.0 — 10.0°  "       [100.4—104.0°   "] 
Dog    ...37.5—39.0°  "       [   99.5—102.2°  "] 
Fowls    ..41.5—42.5°   "       [100.7—108.5°   "] 
The  temperature  will  vary  a  few  tenths  of  a  degree  in 
the  same  species,  and  slight  variations  may  occur  in  one  and 
the  same  animal   w^ithin  a  single  day.     This   latter  variation 
may  amount  to  1°  C.  [1.8°  F.]. 

In  healthy  but  pregnant  cows  the  temperature  may  vary 
1.5°  C.  [2.7°  F.]  ;  a  temperature  elevation,  therefore,  of 
39.9°  C.  [103.8°  F.]  would  not  necessarily  mean  fever  in 
these  animals. 

When  the  organs  (muscles,  glands)  are  active  a  slight 
rise  in  temperature  takes  place,  when  at  rest  a  slight  sinking 
follows. 

From  long  continued  exercise  at  a  rapid  gait  the  tem- 
perature of  a  horse  may  rise  2.5°  C.  [4.5°  F.].  Two  hours 
may  elapse  before  it  reaches  normal  again. 

Fligh  atmospheric  temperatures  or  warm  stables,  inas- 
much as  they  reduce  radiation,  tend  to  increase  the  tempera- 
ture. As  a  rule  the  temperature  is  lower  in  the  morning  than 
toward  evening. 

Age.  race,  sex,  temperament  and  when  eating  have  but 
little  influence  on  bodily  temperature.  During  the  hot  sea- 
son of  the  year,  in  cattle  kept  in  stables  the  temperature  may 
rise  1.0°   C,  for  a  short  time. 

As  a  rule  the  bodily  temperature  is  lowest  in  the  morn- 
ing and  in  the  afternoon  at  about  five  o'clock  highest. 


GENERAL    PART    OF    EXAMINATION.  65 

II.  Temperature  of  the  skin.  The  thinner  and  more 
vascular  the  integument  and  the  finer  the  hair  coat,  the 
warmer  the  organ  feels.  Exposed  sur.faces  of  the  skin  feel 
cooler  than  more  protected,  covered  parts.  The  ears  and 
extremities,  therefore,  are  normally  colder  than  the  rest  of  the 
body. 

The  surface  temperature  is  measured  by  lading  our  hands 
upon  the  skin.  During  fever  the  distribution  of  the  bodily 
heat  is  often  irregular,  therefore  it  is  not  uncommon  to  find 
one  leg  cold  while  its  fellow  may  be  abnormally  hot ;  in  •  fever 
in  the  ox,  the  horns  are  sometimes  hot  and  cold  alternately. 
The  taking  of  the  surface  temperature  is  onlv  of  value  in  the 
ox  and  dog,  the  use  of  the  thermometer  being  more  reliable 
in  the  other  animals. 

The  surface  temperature  is  elevated  (skin  hot)  in  fever 
and  during  normal  outbreak  of  sweat.  It  is  reduced  (skin 
cold)  when  the  temperature  is  below  normal  (milk  fever), 
collapse,  during  chill  stage  of  fever  and  in  the  cold  sweat 
which  usually  precedes  death. 

The  temperature  of  the  skin  is  unevenly  distributed  (one 
ear  hot,  the  other  cold,  ends  of  ears  very  hot  or  very  cold, 
legs  cold)  in  fever.  The  horns  of  cattle  frequently  furnish 
an  index  to  the  temperature  of  the  body. 

III.  Fever.  Although  the  character  of  fever  is  not 
expressed  entirely  by  elevation  of  temperature,  we  have  be- 
come accustomed  to  associate  high  temperature  and  fever, 
using  the  terms  as  if  synonymous.  As  a  matter  of  fact,  the 
increased  temperature  is  only  one  of  the  characteristic  and 
most  readily  available  symptoms  in  the  complex  phenomenon 
called  fever.  As  a  rule,  however,  there  is  a  direct  relation- 
ship existing  between  the  height  of  the  temperature  and  the 
degree  of  development  of  the  fever.  At  times  in  the  ox,  the 
increase  of  temperature,  as  measured  by  the  thermometer, 
fails  to  correspond  with  the  degree  of  fever,  which  can  be 
appreciated  by  the  remaining  symptoms. 


66  CLINICAL    DIAGNOSTICS. 

Besides  mere  increase  in  temperature,  the  following  phe- 
nomena attend  fever: 

1.  Chili  When  the  temperature  of  the  body  rises  very 
rapidly  the  peculiar  symptoms  of  chill  are  shown :  pronounced 
trembling  of  the  muscles,  which  can  shake  the  whole  body, 
arched  back,  erect  hair  coat,  cold  skin.  Chill  is  not  a  con- 
stant symptom  of  fever,  occurring  only  in  certain  infectious 
diseases,  such  as  anthrax,  bovine  pest,  septicemia,  pyemia, 
malignant  head  catarrh.  [It  is  sometimes  seen  in  animals 
reacting  to  tuberculin  or  mallein]. 

2.  Uiict'cii  distribtitioii  of  the  external  temperature  of 
the  body.  The  ears,  horns,  nose  and  extremities  are  abnor- 
mally warm  or  cold,  one  extreme  alternating  with  the  other. 
The  muzzle  of  the  ox,  the  nose  of  the  dog  and  the  snout  of 
the  hog  are  dry.  even  creviced  and  alternately  too  hot  or  too 
cold. 

3.  Aeecleration  of  the  pulse  and  respirations  take  place 
more  slowlv  than  the  increase  in  temperature ;  and  they  do 
not  bear  the  same  relationship  to  the  temperature  in  all  fevers. 
The  higher  the  pulse  frequency,  the  more  serious  the  fever, 
the  pulse  becoming  weak  and  the  artery   soft. 

4.  Loss  of  appetite  and  impaired  digestion.  In  fever 
the  secretion  of  the  digestive  juices  is  lessened,  peristalsis 
suppressed    (constipation),   thirst  increased. 

5.  Mental  depression. 

6.  Albuminuria. 

Although  the  variations  in  the  normal  temperature  of  a 
given  animal  are  confined  to  narrow  limits,  when  the  tem- 
perature exceeds  these  limits  w^e  are  not  always  justified  in 
assuming  the  presence  of  fever.  The  physiological  functions 
of  the  organs  can  momentarily  become  sufficiently  accelerated 
to  produce  a  degree  of  temperature  in  excess  of  the  usual 
normal  one.  The  appearance  of  concomitant  symptoms  or 
repeated   recording  of  the  temperature  will  generally   decide 


GENERAL    PART    OF    EXAMINATION. 


67 


whether  fever  be  present  or  not.     In  doubtful  cases  we  speak 
of  high  normal  temperature. 

The   following  temperatures   may   be    safely   assumed   to 
indicate  fever: 

In  the  horse  a  temperature  of  39.0°    [103.3°  F.]  and  over. 
In  the  ox  "  40.0°    [104.9°  F.] 

In  the  dog  "  39.3°    [103.5°  F.] 

In  the  ox  and  dog  fever  is  often  present  without  a  rise 
of  temperature.     In  such  cases  we  must  depend  upon  the  sur- 
face temperature  and  the  other  symptoms  of  fever  present. 
Generally   the    height   of   the  •  temperature    expresses   the 

Fig.  17. 


Stad.  incre- 
menti 


Fastigium. 


Stadium  decrementi. 
Crisis 


Febris  continua— Equine  Pleuro-pneumonia. 


height  of  the  fever.     Four  degrees  of  fever  are  distinguished, 
which  for  the  horse  and  dog  are  as  follows : 

1.     Mild  fever  38.5°— 39.5°  C.   [101.3°— 103.1°   F.]. 

3.     Moderate  fever  39.5°— 40.5°  C.  [103.1°— 104.9°  F.]. 

3.  High  fever  40.5° — ±1.5°  C.   [104.9°— 10G.r°  F.]. 

4.  Very   high  fever  or   h  y  p  e  r  p  y  r  e  t  i  c   temperature 
41.5°  C.  [106.7°  F.]  and  over. 

Usually  in  the  horse  even  in  the  most  severe  infectious 
diseases,   the  temperature   does   not   exceed   41.7°    C.    [107.0° 


68 


CLINICAL    DIAGNOSTICS. 


F.]  ;  only  exceptionally,  in  tetanus,  contagious  pleuropneu- 
monia, and  influenza,  is  this  high  mark  passed.  The  highest 
temperature  is  carried  by  fowls,  namely  43,5°  C.  [110,3°  F.]. 
[In  cases  of  "heat  stroke"  in  horses  hyperpyretic  temperature 
may  reach  110°  F.]. 

During  a  single  day  a  febrile  temperature  does  not 
remain  constant,  but  agreeing  with  the  variations  of  the  nor- 
mal temperature,  is  lower  in  the  morning  than  toward  even- 
ing— the  so-called  morning  rcijiissions  and  evening  c.vaccr- 
bations. 


41,0 
40,0 
39,0 

S8,0 
37,0 


m 


I 


n    fj    /y    /f   /6 


Febris  rcmitt ens. South  African  Horse  Sickness. 


Recording  of  the  variations  in  temperature  which  occur 
during  the  course  of  a  disease  is  also  of  great  importance. 
If  the  temperature  is  measured  at  a  certain  time  daily  and 
the  record  expressed  in  a  graphic  manner,  the  so-called  fever 
curve  is  obtained.  From  the  fever  curve  is  recognized  the 
type  of  fever  present. 

In  veterinary  medicine  the  following  types  of  fever  are 
important : 

1.  Continued  fever,  dailv  variation  less  than  1°  C. 
(1.8°   F.). 

2.  Rcn-ittoit   fever,  dailv  variation  over  1°   C. 


GENERAL    PART    Or     EXAMINATION. 


69 


3.  Intermittent   fever,  periodical   tem'porary   fall  to  nor- 
mal temperature. 

4.  Atypical  fever  is  one  having  no  regular  character. 


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Apyrexia.  Relapse. 

Febris  intermittens -Flagelosis  of  the  Horse. 

In  the  course  of  most  infectious  diseases,  three  stages  are 
distinguished,  according  to  the  course  of  the  fever,  viz.: 


41,0 
40,0 
39,0 
38.0 
37,0 


Fig.  20. 

■r      Z      i       ^       S      6      7       8      9      U     ft      -fl     f}     ^v     -ff     /6     o 

f 
^'. 

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liiittiimi™ 

E^-^-  =  E-E  — v-^^^zlz 

rev.  Relapse. 

Abscess  developing 

Febris  atypica— Strangles  of  the  Horse. 


Fall 
after  opening 

Abscess. 


70  CLINICAL    DIAGNOSTICS. 

1.  Stage  of  increasing  temperature  (stadium  incre- 
menti). 

2.  Acme,  temperature   at   its  highest    (fastigium). 

3.  Stage  of  falling  temperature  (stadium  decrementi). 
A  rapid  fall  of  temperature   (within  1-2  days)    is  called 

crisis,  a  gradual  decline,  lysis. 

According  to  duration  we  distinguish:  ephemeral  (one 
day),  acute  and  chronic  fevers. 

IV.  Subnormal  Temperature.  Hypothermia.  Like 
the  high  normal,  the  subnormal  temperature  may  be  physiolog- 
ical. Further,  it  may  come  from  the  fact  that  the  sphincter 
ani  is  relaxed,  or  that  the  thermometer  has  not  been  inserted 
deep  enough,  or  that  the  rectum  is  filled  with  feces,  or  that 
defecation  takes  place  just  before  or  during  the  insertion  of 
the  instrument. 

A  subnormal  temperature  due  to  disease  is  unconimcn. 
It  is  seen  to  occur,  but  not  constantly,  in  parturient  paresis, 
■  certain  gastro-intcntinal  diseases  of  the  dog,  anemia,  hemor- 
rhage, icterus  gravis.  A  subnormal  temperature  is  mo3t  fre- 
quent in  fatal  diseases  just  before  death  (temperature  of  col- 
lapse). 

General  Infectious  Diseases. 

Septicemia.  Nearly  all  forms  of  so-called  "Blood  Poisonings" 
are  designated  by  the  collective  term  Septicemia.  Symptoms: 
suddenly  appearing  fever,  often  accompanied  by  chill;  fever  of  the 
continued  type;  mucous  membranes  highly  reddened,  often  icteric, 
frequently  ecchymosed.  Very  rapid,  small  pulse.  Food  and  drink 
refused;  fetid  diarrhea.  Great  mental  depression,  blank  counte- 
nance,   eyes    sunken.      Acute   or   peracute    course. 

Pyemia  is  a  general  disease  due  to  pus  cocci  gaining  access  to 
the  blood,  and  is  characterized  by  multiple,  secondary  abscess  for- 
mation (pyemic  metastasis)  in  the  various  organs,  lungs,  liver, 
kidneys,  brain,  joints,  etc.  Diagnosis  is  easy  when  primary  abscess 
is  available;  otherwise  it  is  difficult.  As  each  new  abscess  forms 
the  temperature  increases,  therefore  it  is  fever  of  intermittent  type. 
Mucous  membranes  are  congested,  icteric.  Pulse  is  continued 
high.     Course  subacute. 


GENERAL     PART    OF    EXAMINATION. 


71 


days. 


Anthrax  IS  an  acute  infectious  disease  due  to  the  Bacillus 
anthrans  Begins  suddenly  with  high  fever;  tendency  toward 
hemorrhages  from  mucous  membranes.  In  the  ox  and  sheep  the 
course  is  often  apoplectic;  when  course  is  acute  it  lasts  1-3 
is  r  a  1  n      symptoms,  pj^  2i 

convulsive        twitch-  ax' 

ings  of  muscles,  rap- 
id pulse,  dyspnea, 
loss  of  milk,  are 
symptoms  s  o  m  e  - 
times  seen.  In  horse,  ** 
colic  symptoms  oc-  b 
cur.  Formation  of 
anthrax  carbuncle  in 
skin  is  not  rare  in 
the  horse.  In  hog, 
symptoms  of  severe 
laryngo  -  pharyngitis 
with  swelling  pre- 
dominate. Diagnosis 
is  positive  only  after 
finding  bacilli  under 
the  microscope.  An 
anthrax  slide  is  made 
as  follows:  A  thin 
layer  of  blood  or 
spleen  pulp  is  smeared 
the    flame   of   a    Bunsen 

solution  of  safranin  and  allowed  to  boil  by  holdin 
flame  for  a  few  moments.     Wash  and  examine. 

The  anthrax  bacilli  are  from  1  to  2  times  as  long  as  the  diame- 
ter of_  a  red  -blood  corpuscle,  and  are  composed  of  from  2  to  8 
bacterial  cells,  which  are  stained  reddish  brown  on  the  slide  Each 
bacterial  cell  is  cylindrical,  slightly  longer  than  broad,  appearing 
almost  squfre  in  form.  The  ends  are  plane  or  somewhat  convex 
ihe  bacterial  cells  are  surrounded  by  a  gelatinous  capsule  which 
IS  stained  yellow  in  the  preparation,  and  which  joins  the  cells 
together  to  form  the  bacillus.  The  capsule  is  bounded  by  a  dark 
line.  If  the  bacilli  come  m  contact  with  one  another  they  unite 
their   capsules   blending  together. 

Influenza.  An  acute,  infectious  disease  of  the  horse  very 
easily  transmitted.  Period  of  incubation  5  to  7  days.  First  'symp- 
a  rise  in  temperature  which  continues  3  to  6  days,  then 
Great  debility,  slow  gait,  staggering,  great  mental  depres- 
sion head  held  down  or  rested  on  manger,  eyelids  and  conjunctiva 
swollen,  hot,  painful,  photophobia.-  Pulse  at  first  strong,  little 
affected,  later  accelerated.  Loss  of  appetite,  diarrhea 
3  days.  In  later  stages  cold,  painless  edematous  swelli 
extremities.     Mortality  4%. 

[Swine  Plague  and  Hog  Cholera.  Infectious  diseases  of  swine, 
caused  by  bacilli  which  enter  the  body  through  the  respiratory 
tract  (swine  plague  of  Smith),  or  via  respiratory  tract  or  mouth- 


Anthrax  bacilli  Stained  according  to  Olt's  method, 
a.  b..  Cadaver  bacilli. 

over   a    slide,   passed   three   times   through 

burner,    then    covered    with    a    2%    watery 

r  a  Bunsen 


tom 
crisis 


in    about 
ng  of   the 


'*  CLINICAL    DIAGNOSTICS. 

with  food  and  water — (hog  cholera  of  Smith).  Period  of  incuba- 
tion 4  to  21  days.  Young  pigs  most  predisposed.  One  attack  pro- 
duces immunity  in  most  cases.  Symptoms:  apoplectic  form;  die 
very  suddenly  or  after  a  few  hours  illness  (beginning  of  an  out- 
break). Usual  form:  fever,  temperature  107°-108°F.,  appetite  im- 
paired, tremblings  of  muscles,  unwillingness  to  move,  stupid,  dull, 
hide  hi  litter.  Bowels  at  first  constipated;  later  diarrhea.  Eye- 
lids filled  with  mucus.  Respiration  accelerated,  labored;  painful, 
frequent  cough.  On  pendant  parts  of  body,  skin  is  reddened,  con- 
gested; eczematous  eruptions,  ulceration  of  skin.  Rapid  loss  of 
flesh,  unsteady,  tottering  gait.  Death  within  48  hours  to  2  weeks. 
Mortality  20-1007o. 

Texas  Fever.  An  infectious  blood  disease  of  the  ox  caused 
by  a  protozoon  (Pyrosoma  bigcminum)  which  enters  and  destroys 
the  red  blood  corpuscles.  The  disease  is  spread  by  the  cattle  tick, 
Boophilus  bovis,  the  younger  generation  of  which  carries  the  pro- 
tozoon. Period  of  incubation  13-90  days  after  exposure  to  tick- 
infected  places.  Symptoms:  fever  (104°-109°  F),  unnatural  recum- 
bent positions  and  standing  attitudes;  animal  is  dull,  stupid;  in 
some  cases  shows  vicious  tendencies;  horns,  ears,  and  hoofs  are 
hot.  Pulse  is  rapid;  dyspnea;  constipation,  excreta  tinged  with 
bile.  Visible  mucous  membranes  icteric.  In  later  stages  urine  red. 
Ticks  of  various  size  to  be  found  on  escutcheon,  inside  of  thighs, 
base  of  udder  or  scrotum.  Little  blood  flows  from  intentional 
wounds.  Characteristic  post-mortem  changes.  Duration  3  days 
to  several  weeks.     Mortality  20-90%]. 

Fowl  Cholera.  Period  of  incubation  1  day.  Apoplectic  death 
common.  Great  exhaustion,  staggering,  foamy  mucus  discharged 
from  bill,  dyspnea  with  respiratory  sounds,  loss  of  appetite, 
diarrhea,  bacilli  as  in  Wild  und  Rinderseuche  (wild  and  cattle 
plague). 

Braxy  of  Sheep.  A  peracute  hemorrhagic  inflammation  of 
the  abomasum  due  to  the  bacillus  gastromycosis  ovis.  In  many 
respects    resembles   anthrax. 

South  African  Horse  Sickness.  A  non-contagious  (though 
readily  transmittable  by  blood  inoculation)  disease  of  horses  and 
mules. _  Incubation  7  days.  Slowly  rising  fever  with  morning 
remissions.  Symptoms  of  pulmonary  edema  (Dumperre  zickte) 
or  swelling  of  the  head  (Dikkop).  Great  muscular  weakness,  ani- 
mals recumbent.  Pulse  not  very  rapid  but  small.  Mortality  80- 
90%. 


B.  The  Special  Part  of  the  Examination. 

6.     Circulatory  Apparatus. 

An  examination  of  the  circulatory  apparatus  is  of  impor- 
tance not  only  to  diagnose  those  maladies  which  afifect  the 
organs  carrying  the  blood,  but  also  from  the  fact  that  all 
acute  general  or  infectious  diseases  of  a  serious  character 
influence  more  or  less  greatly  the  circulation. 

A  methodical  examination  of  the  organs  carrying  the 
blood  includes : 

I.     Taking   the   pulse. 

II.     Noting   the   condition    of   the   peri- 
pheral  blood   vessels. 

III.     Examiningthe   heart. 

I.     Pulse. 

Method  of  Examination.  The  pulse  is  feh  with  the  fingers, 
which  may  be  gently  rested  upon  any  of  the  superficial  arteries 
having  bone  or  other  hard  tissue  under  them.  In  the  horse  and 
ox  the  , sub-maxillary  artery  is  most  commonly  used,  in  the  latter 
animal  th-e  artery  is  easily  felt  on  the  lateral  side  of  the  jaw  bone. 
Other  arteries  which  may  be  used  to  take  the  pulse  are  the  radial, 
plantar,  temporal,  transverse  facial  and  coccygeal.  In  the  dog, 
sheep,  goat  and  cat  the  femoral  artery  is  most  available.  [In 
dogs  and  cats  the  brachial  artery  can  be  felt  on  the  medial  sur- 
face of  the  humerus,  just  in  front  of  and  above  the  elbow].  In 
the  hog  and  fowl  the  pulse  can  not  usually  be  felt,  hence  the 
heart's  beat  is  used. 

From  a  clinical  standpoint  the  1.  Frequency,  2.  Rh\'fh;n, 
and  3.  Quality,  are  of  importance  to  consider  in  examining: 
the  pulse. 

a.  Frequency.  By  the  frequency  of  the  pulce 
we  mean  the  number  of  blood- waves  (beats)  felt  in  a 
minute's    time.      There    is   a   great    variation   in   the    normal 


74  CLIXrCAL    DIAGNOSTICS. 

frequency,  not  only  in  the  different  species  of  animals,  but 
also  in  animals  of  the  same  kind.  Many  physiological  con- 
ditions have  great  influence  upon  the  pulse-frequency :  size, 
age.  sex,  race,  atmospheric  temperature,  time  of  day,  pre- 
hension or  digestion  of  food,  exercise,  excitement,  are  all 
factors. 

Large  animals  carry  a  slowei^  (less  frequent)  pulse  than 
small  ones;  adults  slower  than  young;  females  higher  (more 
frequent)  than  males;  well  bred  individuals,  slower  than 
mongrels ;  in  summer  the  pulse  is  higher  than  in  winter ;  in 
the  morning  slower  than  toward  evening ;  excited  animals 
show  a  more  rapid  pulse  than  animals  standing  at  perfect  rest. 
In  nervous  animals  (horses  and  dogs)  the  act  of  taking  the 
pulse  often  increases  its  frequency. 

Taking  these  physiological  variations  into  consideration, 
the  following  is  the  average  pulse-frequency  for  the  dif- 
ferent animals. 

1.  Horses    in    general 28 —  40. 

Warm    blooded    stallions 28—  32. 

Cold  blooded  stallions 28—  36. 

Colts,  two  weeks  old — 100. 

"       four   weeks   old —  70. 

"       six  to  twelve  months  old 45 —  60. 

"       two  to  three  years  old 40 —  50 

2.  Asses  and  mules 45 —  50. 

3.  Bovines     40—  80. 

4.  Sheep   and   goats 70 —  90. 

5.  Swine    "i 60—100. 

6.  Dogs    ' 60—120. 

7.  Cats    110—130. 

8.  Fowls     120-1  GO. 

Tn  regard  to  frequency  we  distinguish  a  slow  pulre 
(pulsus  ranis)  and  a  rapid  pulse  (pitlsus  frc^jucns). 

The  slow  pulse  {pulsus  varus)  is  very  uncommon.  It 
most  often  accompanies  brain  diseases  attended  b}  great  de- 
pression (chronic  and  subacute  hydrocephalus,  tumors  in  tlv" 
brain),   icterus   gravis,  and  poisoning   fro^n   alcohol   or   lead. 


SPECIAL    CLINICAL    EXAMINATION.  75 

In  the  horse  at  times  it  is  seen  in  gastro-intestinal  affections 
with  loss  of  appetite,  probably  due  to  some  alteration  in  the 
sympathetic  nerve. 


Slow.  Sluggish  Pulse  of  Horse. 
Taken  with  Marey's  Sphygmograph-Art  transversa  faciei. 

The  fast  pulse  (pitlsus  frcqiiciis)  is  very  common  in  dis- 
ease. A  very  rapid  pulse,  though  characteristic  of  no  special 
disease,  is  always  a  sign  that  the  parenchyma  of  the  heart  is 
affected,  hence  in  severe  diseases  it  is  an  index  to  the  heart's 
strength.  Rarely  in  the  horse  does  the  pulse  frequency  exceed 
80  beats  per  minute ;  if  it  exceed  100,  the  prognosis  is  unfa- 
vorable. In  the  ox  a  pulse  of  100,  and  in  the  dog  one  of  120- 
150  denotes  severe  illness. 

An  ab  nor  mall}'  accelerated  pulse  occurs  : 

1.  In  all  severe  diseases,  especially  when  attended  by 
fever.  The  frequency  of  the  pulse,  however,  does  not  always 
bear  the  same  relationship  to  the  height  of  the  temperature ; 
whether  the  pulse  be  accelerated  or  not  depends  upon  the 
fever's  effect  upon  the  heart,  which  dift'ers  with  the  disease 
present.  In  contagious  pleuropneumonia  of  the  horse,  septi- 
cemia, anthrax,  and  severe  inflammations  of  the  bowels  and 
peritoneum,  the  pulse  rate  corresponds  to  the  height  of  the 
fever ;  in  influenza  and  in  strangles,  the  acceleration  of  pulse 
is  not  marked,  compared  with  the  temperature. 

2.  In  painful  conditions  (severe  injuries,  fractures  of 
bones,  abscess  in  hoof,  etc.). 

3.  In  mental  excitement    (fear,   anxiety). 

4.  In  severe  hemorrhage. 

b.  Rhythm.  When  the  individual  pulse  beats  are  sep- 
arated  by   intervals   of   equal   duration,   the   pulse   is   regular 


7b  CLINICAL    DIAGNOSTICS. 

(pulsus  rcgularis).  In  the  dog  and.  according  to  Cadeac, 
frequently  in  mules  and  asses,  the  pulse  is  often  irregular  and 
intermittent. 

Fig,  23. 


Normal  Pulse— Horse. 
Marey's  Sphygmograph  — Art.  trans,  faciei. 

The  rhythm  of  the  irrc'^^ular  and  of  the  intermittent  pulse 
is  abnormal,  i.  e.,  arhyihuiic. 

When  the  pulse  is  irregular  tlie  intervals  between  the 
individual  pulse  beats  are  of  unequal  duration. 

This  is  due  to  lack  of  innervation  of  the  heart,  as  well 
as  to  exhaustion  of  the  organ.  If  the  pulse  of  the  horse 
exceeds  SO  it  is  usually  irregular.  Irregularity  is  also  ob- 
served in  valvular  diseases  of  the  heart,  and  in  myocarditis. 

The  pulse  is  intermittent  when  a  beat  fails  now  and 
then.  When  regularly  intermittent,  a  certain  beat  can  not 
be  felt,  as  for  instance,  every  fourth  or  fifth  pulse  wave ;  when 
irregularly  intermittent  there  is  a  lapse  which  does  not  occur 
between  any  certain  beats.  Sometimes  the  heart's  beat  is 
synchronous  with  the  intermittency  of  the  pulse ;  at  other 
times  the  heart's  beat  is  normal,  the  intermittency  occurring 
only  in  the  peripheral  vessels.  To  determine  this  the  radial 
pulse  and  heart's  beat  can  be  compared. 

The  intermittent  pulse  is  commonly  physiological,  and 
seen  in  perfectly  healthy  horses  and  dogs,  where  it  disappears 
after  exercise  and,  therefore,  probably  due  to  lacking  innerva- 
tion. Pathologically  it  appears  in  chronic  hydrocephalus 
(dummies),  severe  gastric  troubles,  and  during  convales- 
cence from  infectious  diseases  which  have  occasioned  high 
pulse  (contagious  pleuropneumonia  of  the  horse). 


SPECIAL    CLINICAL   EXAMINATION.  77 

c.  Qualify.  The  pulse  beats  should  be  of  equal  vol-- 
nme.  A\nien  this  is  true  we  speak  of  an  equal  pulse  (pulsus 
■aeqtialis). 

The  quality  of  the  pulse  varies  with  the  kind  of  animal. 
The-  normal  size,  strength  and  hardness  of  the 
pulse  can  only  be  learned  by  experience ;  it  can  not  be  defined, 
In  the  horse  the  pulse  is  large,  strong  and  the  artery  only 
moderately  tense ;  in  the  ox  the  pulse  is  smaller,  not  so  strong 
but  the  artery  is  tenser  and  may  be  rolled  under  your  finger 
like  a  hard  rubber  tube.  In  small  animals  the  pulse  is  quick, 
strong  and  hard.     (See  74.)     In  dogs  often  it  is  inequal. 

According  to  whether  a  greater  or  smaller  quantity  of 
blood  is  forced  into  the  arterial  system,  we  distinguish  a 
full  {pulsus  magnus)  and  an  e  m  p  t  y  (pulsus  parvus). 

The  pulse  becomes  empty  when  much  accelerated  and  in 
severe  hemorrhages.  In  fatal  diseases  the  pulse  finally  be- 
comes imperceptible  (pulsus  inscusibUis),  indicating  cardiac 
weakness  or  anemia. 


Small,  Irregular  and  Inequal  Pulse  of  Horse. 
Marey's  Sphygmograph. 

If  the  pulse  waves  are  not  of  equal  volume  the  pulse  is 
"Called  inequal  (pulsus  inacqualis).  This  is  a  very  impor- 
tant symptom  of  cardiac  weakness,  where  it  is  uniformly 
associated  with  irregularity,  and  of  valvular  (uiitral)  heart 
disease.  At  times  there  exists  a  close  relationship  between 
an  irregular  and  an  inequal  pulse.  A  small  wave  follows 
closely  a  larger  one,  so  that  there  is  a  regular  alternation  of 
weak  and  strong  beats.  It  denotes  beginning  heart's  weak- 
ness. 


78  CLINICAL    DIAGXOSTICS. 

By  the  strength  of  the  pulse  we  mean  the  force  with 
which  it  Hfts  the  finger  palpating  it.  We  distinguish  a 
strong  (pulsus  forfis)  and  a  weak  (pulsus  dcbilis).  In 
hypertrophy  of  the  heart  the  pulse  is  strong;  in  parenchyma- 
tous degeneration  of  the  cardiac  muscle,  it  is  weak.  The 
degree  of  weakness  shown  by  the  pulse  indicates  the  severity 
of  the  attack.  We  form  an  estimate  of  the  strength  of  the 
pulse  by  noting  whether  it  is  readily  compressible  or  not. 

The  hardness  of  the  pulse  is  due  to  the  distention  of  the 
arterial  wall  and  is  greatest  at  the  acme  of  a  wave.  The 
pulse  is  hard  (pulsus  durus)  in  severe  pain,  peritonitis,  tetanus 
and  acute  brain  diseases,  fin  inflammation  of  serous  mem- 
branes generally  the  pulse  is  hard].  The  opposite  of  a  hard 
pulse  is  the  soft  pulse   [pulsus  iiwllis). 

Besides  the  above  the  'following  kinds  of  pulse  deserve 
mention:  Trembling  pulse  (p.  treniulus),  where  the  wave 
in  the  distended  artery  is  so  small  that  only  a  slight  trembling 
can  be  felt.  Thready  pulse  (p.  filifonnis)  is  one  which  is  sO' 
small,  weak  and  soft  as  to  be  hardly  perceptible.  If  asso- 
ciated with  this  pulse  the  visible  mucous  membranes  are 
cyanotic,  it  shows  deficient  heart's  strength  and  justifies  a  bad 
prognosis.  The  zviry  pulse  is  a  small,  tense  and  very  hard 
pulse.  Occurring  in  colic  it  is  a  bad  sign.  A  less  marked 
wiry  pulse  may  be  noted  in  aortic  stenosis  and  in  chronic 
nephritis. 

The  arch  of  the  pulse  wave  may  become  changed  in  dis- 
ease. If  the  wave  is  very  abrupt,  we  speak  of  a  hopping,. 
swift  pulse  (p.  celcr)  ;  if,  on  the  contrary,  the  wave  is  much 
prolonged,  it  is  spoken  of  as  a  "sluggish"  pulse   (p.  tardus). 

A  quick  pulse  (p.  cclcr)  is  associated  with  mild  cases 
of  cardiac  hypertrophy,  plainly  marked  in  aortic  insufficiency^ 
In  the  latter  case  it  is  due  to  the  regurgitation  of  the  blood,, 
which  occurs  at  systole,  into  the  hypertrophic  left  ventricle. 
In  both  these  instances  the  pulse  is  full  and  strong.  Remark- 
ably in  heart's  weakness  a  p.  celcr  is  present.     However,  here 


SPECIAL    CLIXICAL    EXAMINATION.  79 

the  pulse  is  weak  and  the  artery  empty.  The  "sluggish"  pulse 
(p.  tardus)  is  noted  in  very  lymphatic  horses  and  is  character- 
istic only  of  aortic  stenosis,  when  it  is  at  the  same  time 
small. 

■  A  peculiar  pulse  is  the  dicrotic  pulse  where  two  marked 
expansions  can  be  felt  in  one  beat  of  the  artery.  It  is  seen 
in  cases  of  lowered  arterial  tension  combined  with  weak- 
ened heart's  action,  and  is,  therefore,  noted  in  long  continued 
fevers  and  in  all  forms  of  anemia. 

Fig.  25. 

Dicrotic  Pulse— Horse. 
Marey's  Sphygmograph. 

II.     Examination  of  the   Peripheral   Blood   Vessels. 

Arteries.  A  strong  pulse  attending  Avasting  disease 
and  emaciation  calls  for  an  examination  of  the  small  super- 
ficial arteries.  An  abnormally  strong  pulsation  in  the  peri- 
pheral arteries  of  small  caliber  is  visible  in  the  horse  in  the 
branchings  of  the  external  maxillary  artery. 

It  appears  in  hypertrophy  of  the  left  ventricle  especially 
when  the  bicuspid  valves  are  defective. 

Veins.  The  stateofdistentionof  the  veins  is 
of  primary  interest.  The  veins  become  prominent  after  any 
acceleration  of  the  heart's  action  in  thin-skinned,  fine- 
haired  horses;  the  condition,  which  is  physiological,  being  a 
temporary  one.  A  permanent  distention  of  the  veins  is  path- 
ological, and  is  due  to  an  obstruction  of  the  free  flow  of  blood 
to  the  right  heart.  It  is  mostly  plainly  visible  in  the  jugulars 
and  their  plexus  on  the  head,  other  superficial  veins  (external 
thoracics,  milk  veins,  veins  of  the  extremities)  showing  it 
less  on  account  of  the  edema  usually  accompanying  the  con- 
dition. 


80  CLINICAL    DIAGNOSTICS. 

The  ju,c:ulars  can  be  distended  to  the  size  of  the  human 
wrist,  or  even  the  arm,  appearing  as  great,  round  strands. 
The  veins  of  the  conjunctiva  can  also  be  distended,  being  rec- 
ognized as  ramiform,  often  contorted,  bluish  strands  in  the 
mucous  membrane. 

The  veins  are  generally  distended : 

1.  In  valvular  disease  (tricuspid).  It  is  usually  sec- 
ondary, but  in  the  ox  mostly  primary. 

2.  In  chronic  pulmonary  diseases  interfering  with  cir- 
culation :  emphysema. 

3.  In  diseases  of  the  heart's  muscle,  the  organ  having 
become  so  weak  that  it  is  unable  to  handle  the  quantity  of 
blood :  traumatic  myocarditis  of  the  ox. 

■i.  From  excessive  intrathoracic  pressure  upon  the  heart 
and  large  blood  vessels :  tympanitis,  plcuritis,  pericarditis 
traumatica  of  the  ox. 

Pulsation  in  veins.  Besides  being  distended,  veins 
can  show  pulsation  under  some  circumstances.  Synchronous 
with  the  respirations,  and  independent  of  the  heart's  action, 
a  slight  swelling  of  the  jugulars  occurs  during  the  act  of 
expiration,  to  fall  again  at  inspiration.  A  so-called  jugular 
pulse  is  normal  in  the  ox  for  the  following  reasons :  The 
jugulars  and  anterior  vena  cava  in  this  animal  are  compara- 
tively large.  The  continual  flow  of  the  venous  blood  into 
the  right  heart  suffers  during  the  systole  of  the  right  auricle, 
which  slightly  precedes  that  of  the  ventricle,  a  momentary 
interruption,  the  blood  congesting  in  the  anterior  vena  cava 
and  jugulars,  causing  a  brief  distention  of  the  jugulars,  sim- 
ulating a  pulsation.  It  is  therefore  not  an  active  pulsation, 
but  merely  a  passive  undulation  due  to  a  regurgitation  of  the 
blood  in  the  form  of  waves.  The  presystolic  appearance  of 
the  pulse  movement  characterizes  it,  therefore  it  should  al- 
ways be  compared  with  the  arterial  pulse.  The  collapse  of 
the  vein  is  synchronous  with  the  arterial  pulse. 

The  undulation  of  the  jugular  vein  is  intensified  in  the 


SPECIAL    CLINICAL   EXAMINATION.  81 

OX  and  becomes  apparent  in  other  animals  when  the  above 
cited  condition  prevails,  induced  by  a  morbid  congestion  of 
the  blood  at  the  heart.  In  the  horse  the  venous  pulse  is  seen 
near  the  aperture  of  the  thorax  (lower  portion  of  the  neck). 
A  true  (positive)  venous  pulse  is  pathological.  It  is 
coincident  with  the  heart's  systole,  and  is  produced  by  a  de- 
fective closing  of  the  auriculo-ventricular  valves,  the  blood,  re- 
gurgitating into  the  auricle.  True  venous  pulse  is 
a  characteristic  symptom  of  tricuspid  in- 
sufficiency. 

Fig.  26. 


-VWVWv 


Venous  Pulse— Horse. 

The  valves  in  the  jugulars  do  hot  prevent  the  flowing 
back  of  the  blood,  as  they  are  commonly  not  well  developed, 
and  if  the  vein  be  greatly  distended  they  cannot  close  the 
lumen  of  the  vessel. 

III.     The  Heart. 

The  heart  is  examined  by  palpation,  percussion 
and  auscultation. 

Anatomical.  In  all  domestic  animals  the  heart  lies  in  the  ven- 
tral portion  of  the  thoracic  cavity  between  the  third  and  sixth 
ribs,  in  the  dog  extending  to  the  seventh  rib.  The  great  mass 
of  the  organ  (3-5)  lies  to  the  left  of  the  median  line,  so  that  it 
approaches  nearer  the  left  thoracic  wall  than  the  right  one.  It 
does  not  occupy  a  perpendicular  position,  but  an  oblique  one 
directed  from  the  right,  in  front  and  above  to  the  left,  backward 
and  downward,   the  left  side   of  the   apex  reaching  the   chest  wall. 

Horse.  The  base  of  the  heart  lies  below  the  upper  half  of 
the  height  of  the  chest  cavity,  resting  against  the  thoracic  wall 
between  the  4th  and  5th  intercostal  space.  The  point  of  contact 
occupies  a  surface  of  about  10  cm  high  and  6-8  cm  broad.  (Sec- 
Fig.  27,  page  87). 

Ox  and  small  ruminants.  The  heart  is  smaller  and 
does  not  extend  quite  as  far  back  as  the  6th  rib,  its  base,  however, 
extends  to  the  median  line  of  the  chest.     Between  the  4th  and  5th 


82  CLINICAL    DIAGNOSTICS. 

ribs   it  comes  in   immediate  contact  with   the  thoracic  wall.      (See 
Fig.  26.) 

Dog.  The  heart  is  of  rounder  form  and  lies  very  obliquely, 
touching  the  chest  wall  along  a  narrow  strip  from  the  4th  to  the 
7th  ribs.  The  apex  is  below  the  6th  intercostal  space.  (See 
Fig.  27.) 

Palpation  of  the  heart's  region.  The  beat  of  the  heart  can 
be  felt  by  laying  the  flat  of  the  hand  over  the  cardiac  region. 
Inasmuch  as  the  anconeus  muscles  partly  cover  the  region,  the 
hand  should  be  placed  between  them  and  the  chest  wall.  In 
the  depths  a  dull  thud  will  be  felt,  produced  by  the  thumping 
of  the  heart  against  the  chest  wall.  The  beat  is  due  to  a  con- 
traction of  the  heart's  muscles  which  causes  a  slight  torsion  of 
the  organ  to  the  left,  bringing  the  left  side,  not  the  apex, 
in  contact  with  the  wall  of  the  chest.  The  beat  can  best  be  felt 
in  all  animals  just  at  the  5th  intercostal  space  at  the  union  of 
the  ribs  to  the  cartilages  of  the  sternum.  The  force  with  which 
the  beat  can  be  felt  depends  upon  the  condition  of  the  animal 
as  to  flesh,  it  being  more  plainl)'  marked  in  thin  animals,  and 
just  after  severe  exercise  or  excitement.  Only  in  the  dog  can 
the  heart's   beat   be   felt   normally   on   the   right   side. 

The  force  of  the  heart's  beat  can  be  increased 
or  diminished.  When  the  force  of  the  beat  is  much  increased 
a  palpitation  of  the  heart  is  spoken  of.     It  occurs : 

1.  In  hypertrophy  of  the  heart  (here  combined  with 
strong  pulse). 

2.  In  heart's  weakness,  the  muscles  of  the  organ  un- 
dergoing spasm-like  contractions  incapable  of  properly  pro- 
pelling the  blood  to  the  periphery,  the  pulse  being  small.  The  ■ 
condition  is  seen  in  acute  myocarditis,  endocarditis  and  peri- 
carditis. 

3.  Where  the  lung  between  the  heart  and  the  chest  wall 
becomes  thickened. 

The  heart's   beat   is    weakened: 

1.  Where  the  force  is  enfeebled  from  degeneration  of 
the  heart's  muscle. 

2.  Where  the  heart  is  crowded  away  from  the  chest 
wall  by  accumulations  of  exudate  in  the  thoracic  cavity 
(pleuritis,  pericarditis),  or  in  some  cases  of  pulmonary  em- 
physema or  tumors. 

Percussion  of  the  heart.  Except  in  very  thin  animals 
(horses)  the  percussion  of  the  heart  is  of  no  great  value  in 


SPECIAL    CLINICAL   EXAMINATION.  83 

the  diagnosis  of  disease,  the  reason  being  that  with  the  per- 
cussion hammer  we  are  unable  to  determine  the  boundaries 
of  the  organ,  the  adjacent  lung  tissue  so  modifying  the  sound 
that  the  merging  of  the  dull  sound  of  the  heart's  percussion 
into  the  /;///  sound  of  the  lung's  is  a  very  gradual  one. 

Horse.  In  the  horse,  under  favorable  circumstances,  in  the 
region  of  the  4th  and  5th  intercostal  space  a  zone  of  dullness 
about  the  size  of  a  hand  can  be  brought  out  by  percussion.  Its 
boundaries,  however,  are  generally  indefinite. 

Ox.  Although  the  chest  walls  are  thinner  in  this  animal,  the 
heart  is  covered  more  by  the  lungs  than  in  the  horse. 

Dog.  A  narrow  horizontal  line  of  dullness  between  the  4th 
and   7th   ribs   can   be   determined   by   vigorous   percussion. 

The  zone  of  cardiac  dullness  is  in- 
creased in  hypertrophy  of  the  heart  and  where  fluids  col- 
lect in  the  pericardium  ;  tumors  and  thickenings  of  the  lungs 
also  induce  it. 

The  zone  of  cardiac  dullness  is  some- 
times decreased  from  pulmonary  emphysema. 

A  tympanitic  tone  on  percussion  over  the  cardiac 
region  is  obtained  in  traumatic  pericarditis  of  the  ox,  gases 
of  putrefaction  accumulating  in  the  pericardium. 

The  percussion  of  the  cardiac  region  causes  the  animal 
pain  in  pleuritis  and  pericarditis. 

The  Auscultation  of  the  Heart. 

Method.  The  auscultation  of  the  heart  may  be  practiced  by 
placing  the  right  ear  just  behind  the  left  elbow,  the  leg  being 
drawn  forward.  Small  animals  may  be  laid  upon  the  table  and  the 
phonendoscope   used. 

Physiology.  In  the  cardiac  region  and  in  the  neighborhood  of 
the  same,  we  hear  at  each  action  of  the  heart  two  tones.  One 
of  these  tones  appears  at  the  moment  the  organ  contracts  {sys- 
tole), and  the  second  tone,  which  quickly  follows  the  first,  at  the 
dilation  of  the  organ  {diastole).  The  second  tone  follows  so 
closely  the  first  one  that  it  is  diflficult  to  differentiate  between 
them,  except  in  animals  which  carry  a  pulse  below  60.  In  ani- 
mals which  have  rapid  pulse  it  may  be  necessary  to  compare  the 
pulse  at  a  peripheral  artery  with  the  heart's  beat. 

The  origin  of  the  heart-tones  is  still  subject  to  dispute,  the 
authorities  not  agreeing. 


8-i  CLINICAL    DIAGNOSTICS. 

[The  first  heart-sound  (the  systolic)  is  caused  by  the  con- 
tracting muscles  of  the  organ  and  the  closing  of  the  auriculo-ven- 
tricular  valves.  The  second  sound  is  produced  by  the  closing  of 
the  semilunar  valves]. 

The  first  sound  in  our  domestic  animals  is  duller,  deeper^ 
more  prolonged  and  usually  louder  than  the  second  one.  which 
is  short,  not  so  deep,  well  defined  (sharper),  not  so  loud,  and 
at  times  slightly  metallic.  There  is  a  great  variation  in  the 
sound  produced  by  the  heart  in  the  dififerent  animals,  and  even 
in  animals  of  the  same  species,  the  sounds  being  in  one  case 
sharper  (more  metallic)  and  in  another  deeper  and  duller. 
The  thickness  of  the  chest  walls  is  also  of  influence,  in  ani- 
mals with  well  muscled  chests  the  sounds  are  seemingly  more 
muffled,  duller.  By  pronouncing  the  syllables  hib-duh  one  can. 
mimic  the  sounds  of  the  heart. 

I  II  I  II 

lub  dub  lub  dub 

Change  in  Heart-Sounds  Due  to  Disease. 
Both  sounds  are  increased  in: 

1.  Hypertrophy  of  the  heart,  the  valves  remaining  in- 
tact,    (idiopathic  hypertrophy). 

2.  Anemias. 

3.  A  thickening  of  the  lung  tissue  around  the  heart, 
producing  a  better  conductor  of  sound. 

The  second  sound  only  is  increased: 

When  the  arteries  are  greatly  distended,  not  infrequently 
the  result  of  a  congestion  of  the  pulmonary  circulation  com- 
bined with   hypertrophy  of  the  heart. 

Both  sounds  are  zveakened  when  the  normal  heart  be- 
comes enfeebled  through  disease  of  its  parenchyma,  or  where 
the  hypertrophic  organ  is  exhausted. 

Metallic  tones .  occurring  during  systole  are  very  com- 
mon in  anemic  animals.  In  traumatic  pericarditis  of  the 
ox,  the  pericardium  containing  gas,  a  loud  metallic  tone  is 
heard  at  each  systole  when  the  heart-muscle  is  still  vigorous. 


SPECIAL    CLINICAL   EXAMINATION.  85 

Sometimes  the  sound  can  be  plainly  heard  the  distance  of 
several  paces  from  the  affected  animal. 

This  is  due  to  the  accumulation  of  gas  in  the  pericardium 
acting  as  a  resonant  mechanism  which  augments  the  sound. 

The  first  tone  is  dull  in  heart's  weakness  and  in  myocar- 
ditis, especially  noticeable  in  acute  infectious  diseases. 

A  splitting  W^—^^l — -—I  or  doubling  |— --| — — |  of  the 
heart  sounds,  the  condition  of  the  circulatory  apparatus  being 
otherwise  normal,  is  of  no  significance.  Commonly  the  first 
sound  is  preceded  by  a  short  tone  -| 1 ,  which  is  pro- 
duced by  the  contracting  of  an  unusually  well  developed 
auricle. 

Heart  bruits.  Heart  bruits  are  abnormal 
sounds  and  are  therefore  pathological.  They  are  caused 
by  the  sound  producing  parts  of  the  organ  vibrating  for  too 
long  a  time.  Endocardial  bruits  and  pericardial  bruits  are 
distinguished. 

a.  Endocardial  bruits  (noises)  come  from 
within  the  heart  and  are  closely  connected  with  the  heart 
sounds.  We  can  distinguish,  therefore,  systolic  bruits  and 
diastolic  bruits,  depending  upon  whether  they  occur  at  the 
first  or  second  sound.  If  the  bruits  are  produced  by  anatomi- 
cal changes  of  the  heart  itself,  they  are  called  organic,  other- 
wise inorganic. 

a.  The  organic  or  endocardial  heart  bruits  are  caused 
either  by  a  narrowing  (stenosis)  of  the  auriculo-ventri- 
cular  or  arterial  openings  or  by  alterations  on  the  valves  pre- 
venting them  from  closing  properly  (insufficiency). 
They  form  most  valuable  symptoms  in  the  diagnosis  of  heart 
diseases. 

Instenosisthe  bruitoccursatthemoment 
the  blood  passes  the  contracted  orifice,  the 
walls  of  which  are  set  in  vibration.  If  the  stenosis  involves 
the  auriculo-ventricular  opening  the  bruit  occurs  at  diastole,  if 
in  the  arterial  openings,  at  systole. 


Sb  CLINICAL    DIAGNOSTICS. 

In  insufficienc}-  the  bruit  occurs  at  the 
moment  at  which  the  valves  should  close.  In 
consequence  of  their  inability  to  close  a  regurgitation  of  the 
blood  takes  place,  which  produces  a  renewed  vibration  of  the 
valves,  and  gives  a  bruit.  If  the  insufficiency  involves  the 
auriculo-ventricular  valves,  the  bruit  occurs  at  systole;  if  the 
semilunar  valves  are  insufficient  the  bruit  appears  at  diastole: 

The  character  of  the  bruits  is  varied,  they  can  be  biia- 
singj  blozi'ing,  purring,  hissing,  Jinmming,  sazcing,  rattling, 
long  or  short  tones.  Insufficiency  bruits  are  generally  softer 
than  those  due  to  stenosis.  Heart  bruits  are  made  more 
pronounced  by  an  acceleration  of  the  heart's  action,  therefore 
the  patient  should  be  exercised  before  examination. 

Gmelin  recommends  digitalinum  vernui  subcutaneously  to 
bring  out  more  distinctly  heart  sounds  or  casual  bruits.  The 
dose  for  the  horse  and  ox  is  0.025 — 0.05 ;  for  the  dog  0.002 
0.009.  The  digitalin  is  first  dissolved  in  5ccm  of  50%  alcohol 
and  then  diluted  with  SOccm  of  water. 


Systolic    bruits  I^N^^/N- I  are  characteristic  of: 


I  Insufficiency 

I  of  an  auric- 

I  ulo-  ventric- 

\  ular  valve. 

I  Stenosis       of 

I  an      arterial 

[  opening. 


Diastolic  bruits]  — v^n^  [  are  characteristic  of : 


Stenosis  of 
an  auricu- 
lo-ventricu- 
lar opening. 
Insufficiency 
of  a  semi- 
lunar   valve. 


SPECIAL    CLINICAL   EXAMINATION. 


87 


Although  the  bruits  originate  in  different  parts  of  the 
heart,  the  exact  point  of  origin  cannot  be  determined  by- 
auscultation.  In  the  horse  and  dog  valvular  lesions  have  their 
seat  most  commonly  in  the  left  heart,  rarely  are  they  primary 
in  the  right  heart.  In  the  ox  valvular  diseases  of  the  right 
heart  are  more  frequent  than  of  the  left  one.     The  auriculo- 

Fig.  27. 


Points  at  which  Endocardial  Bruits  are  most  pronounced. 
-Line  of  Shoulder.      1.— Left  Auriculoventricular  Opening.       2.  — Portal, 
monary  Artery. 


ventricular  valves  are  more  commonly  diseased  than  the  semi- 
lunar. 

b.  Contrary  to  the  endocardial,  organic  bruits,  the 
inorganic  or  anemic  bruits  occur  without  that  any  discernible 
anatomical  alteration  appears  at  the  orifices  or  valves  of  the 
heart.  Inorganic  bruits  are  systolic,  soft,  blowing  and  not 
constant   (accidental).     They  tend  to  disappear  and  reappear 


88  CLINICAL    DIAGNOSTICS. 

again.  Their  origin  is  not  well  understood.  They  are  nearly 
always  noted  in  anemic  animals. 

It  is  very  important  to  distinguish  between  or- 
ganic and  inorganic  heart  bruits,  but  in  practice 
this  is  often  very  difficult.  As  a  rule,  soft,  systolic  bruits 
(they  do  not  occur  during  diastole)  should  be  very  carefully 
estimated.  Organic  heart  bruits  are  always  accompanied  by 
hypertrophy  and  often  alteration  of  pulse,  and  frequently 
venous  congestion. 

b.  The  pericardial  bruits.  These  bruits  do 
not  come  from  within  the  heart  itself,  but  are  extra-cardial. 
They  consist  in  frictional  noises  due  to  the  pericardium  having 
become  so  altered  that  its  surface  is  no  longer  smooth  and 
slippery,  but  rough  and  dry.  The  bruits  are  characterized  by 
being  scratching,  grating  or  rubbing,  frictional  tones  not  in- 
timately related  to  either  systole  or  diastole.  Pericardial  bruits, 
when  present,  muffle  the  regular  heart  sounds. 

A  pericardial  metallic  gurgling  or  liquid  bruit,  synchron- 
ous with  the  heart's  beat,  occurs  in  the  course  of  traumatic 
pericarditis  when  fluid  exudate  and  gas  commingle  in  the  per- 
icardium. 

Diseases  of  the  Circulatory  Apparatus. 

Acute  myocarditis.  A  diffuse  parenchymatous  affection  of  the 
heart's  muscle  whicli  attends  severe  infectious  diseases.  Symp- 
toms: great  weakness  and  debility,  mucous  membranes  cyanotic, 
high  fever,  heart's  beat  weak,  systolic  sound  mutfled.  Pulse  very 
rapid  up  to  1:20  in  the  horse;  small,  weak,  arhythmic,  inequal, 
finally   imperceptible.      Course  acute   or   peracute.      Mortality   high. 

Hypertrophy  and  dilatation  of  the  heart.  Can  be  present  for 
years  without  visiljle  symptoms  occurring.  Symptoms:  Pulse 
strong,  also  heart  impulse,  zone  of  cardiac  dullness  enlarged  on 
percussion.  Later  when  the  heart  is  greatly  dilated  and  the  valves 
can  no  longer  close  sufficiently,  symptoms  of  bicuspid  insufficiency 
occur;  pulse  rapid,  arhythmic,  inequal;  heart's  beat  sometirnes 
palpitating,  increased  dullness  on  percussion.  Systolic  blowing 
bruit,  diastolic  sound  intact  or  louder  than  normal.  Exercise 
causes  dyspnea  from  pulmonary  venous  congestion.  Termina- 
tion as  in  chronic  valvular  disease.  Most  common  heart  disease 
of  horse  and  dog.  ^ 


SPECIAL    CLINICAL    EXAMINATION.  89 

Acute  endocarditis.  Not  very  common.  Fever,  greatly  ac- 
•celerated  heart's  action,  irregular  pulse,  intermittent,  very  small. 
"Heart  sounds  are  at  tirst  normal,  later  systolic  bruit.  Dyspnea. 
General   condition   altered.      Prognosis   unfavorable. 

Valvular  disease,  chronic  endocarditis.  Caused  by  a  chronic 
valvular  endocarditis  which  leads  to  an  atrophy  of  the  valves 
(insufficiency)  or  to  a  narrowing  of  the  orifices  (stenosis).  Fol- 
lowing valvular  failure  a  hypertrophy  of  the  ventricle  always  takes 
place;  in  disease  of  the  semilunar  valves  the  left  ventricle,  in 
defects  of  the  mitral  valve  a  hypertrophy  of  the  right  ventricle. 
The  hypertrophy  of  the  ventricle,  which  is  combined  with  dila- 
tation, is  compensatory. 

Bicuspid  (Mitral)  insufficiency.  Most  common  form 
of  heart  disease  in  dogs  and  horses.  Pulse  small,  irregular.  Sys- 
tolic bruit.     Diastolic  sound  clear,  loud.       Dyspnea  on  exercise. 

Stenosis  of  the  bicuspid  (Mitral)  valves.  Rare 
when  unattended  with  insufficiency;  an  uncommon  lesion  com- 
pared with  insufficiency.  Pulse  small  and  very  weak.  Diastolic 
and  pre-systolic  bruits.     Great  dyspnea. 

Insufficiency  of  the  tricuspid  valves.  Rarely 
primary  in  the  horse,  mostly  secondary  to  diseases  involving  the 
left  ventricle,  leading  to  hypertrophy  of  the  right  heart.  In  the 
ox  frequently  primary.  Systolic  bruits,  venous  congestion,  venous 
pulse. 

Stenosis  of  the  tricuspid  valves.  Happens  only 
in  the  o.x  and  is  then  combined  with  insufficiency.  Diastolic  bruits, 
great  venous  congestion,  dyspnea. 

Insufficiency  of  the  aortic  semilunar  valves. 
Full,  strong,  hopping  pulse,  pulsation  in  peripheral  arteries. 
Diastolic   bruit.      Hypertrophy   of  the   left   heart. 

Stenosis  of  the  aorta.  Mostly  combined  with  insuf- 
ficiency. Harsh  systolic  bruit.  Long-drawn-out,  slow,  small  pulse 
(28-32  in  the  horse).  Hypertrophy,  attacks  of  vertigo  during  exer- 
cise  (work). 

Valvular  diseases  of  the  pulmonary  artery 
are  very  rare. 

Termination  of  all  valvular  diseases.  In 
chronic  heart  diseases  the  dilatation  of  the  ventricle  is  followed  by 
a  relative  insufficiency  of  the  valves.  Semilunar  defects  lead  to 
a  relative  insufficiency  of  bicuspids;  bicuspid  defects  to  a  relative 
insufficiency  of  the  tricuspids.  The  special  diagnosis  of  the  pri- 
mary lesion  is  then  very  difficult.  As  sequela,  finally,  the  follow- 
ing symptoms  appear:  small,  irregular  pulse,  systolic  and  diastolic 
bruits,  congestion  of  veins,  venous  pulse,  edemas,  dyspnea, 
albuminuria,  dropsy,  attacks  of  vertigo,  emaciation  and  great 
weakness. 

Pericarditis.  Mostly  a  symptom  of  other  diseases.  Moderate 
fever,  congestion  of  mucous  membranes.  Pulse  rapid,  heart's 
beat  weak  or  imperceptible,  zone  of  cardiac  dullness  increased, 
pericardial   (frictional)    bruits,  which  disappear  when   fluid  exudate 


90  CLINICAL    DIAGNOSTICS. 

becomes  prevalent.     Tlie  pressure   of  the  exudate  upon    the  veins 
causes  congestion  in  jugulars   (venous  pulse). 

Traumatic  pericarditis  of  the  ox.  Begins  usually  with  the 
symptoms  of  an  acute  indigestion  (traumatic  inflammation  of  the 
stomach  and  diaphragm),  which  may  continue  for  some  time.  If 
the  pointed  foreign  body  is  driven  forward,  which  is  commonly 
caused  by  the  expulsive  efiforts  of  the  abdominal  muscles  during 
the  act  of  parturition,  it  usually  reaches  the  heart.  The  general 
condition  of  the  patient  is  greatly  disturbed,  the  expression  com- 
plaining, anxious.  The  animals  stand  with  back  arched  and  held 
stiffly,  do  not  like  to  lie  down,  and  when  recumbent  rest  con- 
tinually on  the  sternum.  *  When  arising  they  utter  complaints. 
Temperature  variable,  external  (surface)  temi)erature  never  quite 
normal.  Pulse  rapid,  artery  tense.  Heart  beat  cannot  be  felt, 
zone  of  cardiac  dullness  increased  and  tympanitic  when  gas  has 
accumulated  in  the  pericardium.  On  auscultation  in  the  earlier 
stages  pericardial  frictional  bruits,  heart  sounds  clear,  when  much 
exudate  is  present  weak;  systolic  bruits  of  a  metallic  character 
in  consequence  of  spasm-like  contractions  of  the  heart.  When 
putrefactive  gases  are  present  the  heart  sounds  can -be  so  loud 
and  metallic  as  to  be  heard  at  a  distance.  Jugulars  distended,, 
pulsating  (undulating),  edema  of  brisket,  neck  and  throat.  Course 
chronic   notwithstanding  severity  of  the   ailment.      Prognosis   bad. 

7.     Respiratory  Apparatus. 

The  examination  of  the  respiratory- 
tract  is  one  of  the  most  important  re- 
sponsibilities of  the  veterinarian,  first 
because  it  is  frequently  subject  to  disease,  and  secondly  froin 
its  availability  to  thorough  inspection. 

From  the  complex  anatomy  of  the  apparatus,  and  the 
value  to  diagnostics  of  the  varied  clinical  phenomena  it  mani- 
fests in  disease,  a  searching  examination  of  the  respiratory 
tract  can  only  be  made  by  following  a  definite  system. 

The  examination  would  include  attention  to  the  following : 
I.     The    r  e  s  p  i  r  a  t  o  r  y   m  o  V  e  m  e  n  t  s     (res- 
pirations). 
II.     The    breath. 

III.  The    nasal    discharge. 

IV.  The     nasal     cavities     and     adjacent 

sinuses. 
V.     The     submaxillary    lymph    glands. 


RESPIRATORY  APPARATUS.  91 

VI.  The    cough. 

VII.  The    voice. 

VIII.  The    laryngeal    region. 

IX.  T  h  e    t  r  a  c  h  e  a  . 

X.  The    percussion    of    the    thorax. 

XL  The   auscultation   of   the    thorax. 

1.     The  Respiratory  Movements.    [Respirations]. 

The  respirations  should  be  examined  in  regard  to  fre- 
quency, manner  in  which  produced,  and  any  special 
sounds  originating  during  the  act  of  breathing.  These 
three  factors  help  to  determine  whether  dyspnea  be 
present  or  not. 

Frequency  of  respirations.  To  determine  the  number  of  res- 
piratory movements  per  minute  each  rise  or  fall  of  the  flanks 
or  ribs  is  counted.  Observing  the  play  of  the  nostrils  is  not  as 
certain  a  method,  as  these  organs  can  be  voluntarily  moved  by 
the  animal.  In  winter  the  breath  can  be  seen  appearing  as  steam 
at  each  expiration.  The  respirations  should  be  counted  for  at 
least  thirty  seconds;  in  restless  animals  the  veterinarian  should 
stand  quietly  near,  count  several  times  and  take  the  average  ob- 
tained  as   the   respiratory   frequency. 

The  smaller  the  animal  the  greater  the  number  of  respira- 
tions. In  one  and  the  same  animal  the  number  of  respirations 
per  minute  will  vary  within  physiological  limits. 

Just  after  partaking  of  food,  or  when  the  abdomen  is  very 
full,  and  especially  after  exercise,  an  acceleration  of  respira- 
tions is  a  normal  consequence.  High  atmospheric  tempera- 
tures, restlessness  and  anxiety,  also  make  the  breathing  more 
hurried.  In  adult  animals  standing  at  perfect  rest  the  follow- 
ing number  of  respiratory  movements  per  minute  may  be 
taken  as  the  average  normal : 

Horse 8-16 

Ox 10-30 

Sheep  and  goat 12-30 

Swine 10-20 

Dogs 10-30 

Cats 20-30 

Fowls 40-50 


92  CLINICAL    DIAGNOSTICS. 

A  pathological  increase  in  the  number  of  respiratory 
movements  is  spoken  of  as  dyspnea  (see  this).  A  decrease  in 
the  number  of  respiratory  movements  is  rarely  observed.  It  is 
seen  in  severe  brain  affections  (hemorrhage,  hydrocephalus, 
tumors,  poisonings,  action  of  septic  substances  during  the 
course  of  pulmonary  gangrene),  also  where  the  anterior  air 
passages  are  occluded  (stenosis),  which  is  combined  with  a 
pronounced  inspiratory  tone. 

Physiology  of  respiration.  When  an  animal  is  at 
perfect  rest,  the  respirations  are  produced  by  the  action  of  the 
diaphragm.  The  contraction  of  the  diaphragm  produces  a  dihi- 
tation  of  the  thorax.  When  the  organ  contracts  it  flattens  and  is 
drawn  backwardly,  the  false  ribs  becoming  elevated.  Notwith- 
standing that  the  diaphragm  is  stretched 
transversely  between  the  thoracic  and  ab- 
dominal cavities,  its  contraction  does  not 
■cause  its  points  of  insertion  to  approach 
each  other,  for  the  reason  that  the  intestines  keep  it  con- 
tinually forward,  which  produces  a  drcmnng  anteriorly  of  the  ribs 
rather  than  to  cause  them  to  approach  the  median  line.  O  n 
account  of  the  double  articulation  of  the 
ribs  with  the  dorsal  vertebrae  the  forward 
movement  of  them  is  accompanied  by  a  rota- 
tion. The  diaphragm  dilates  the  thorax  in  that  it  draws  the  ribs 
forward  and  rotates  them  outward  at  the   same  time. 

The  expiration  follows  the  relaxation  of  the  diaphragm, 
which  takes  place  immediately  after  the  inspiration.  The  dura- 
tion of  expiration  is  longer  than  that  of  inspiration;  between 
them  in  quietly  breathing  animals  there  is  a  short  pause. 

The  normal  rhythm  of  the  respirations  can  be  pathologic- 
ally altered  in  that : 

1.  The  inspiratory  movement  lasts  too  long, 
the  free  entrance  of  air  being  prevented  by  stenosis  of  the 
respiratory  passages. 

2.  The  expiratory  act  lasts  too  long,  the  relax- 
ation of  the  diaphragm  not  sufficing  to  a  complete  expiratory 
movement. 

As  the  respirations  are  in  a  measure  controllable  by  the 
will,  which  depends  upon  the  cerebrum,  excitement  or  inflam- 
matory conditions  occasioning  either  brain  irritation  or  depres- 
sion, at  times  can  bring  about  marked  change  in  the  rhythm 


RESPIRATORY  APPARATUS.  93 

of  respiration.  The  value  of  these  changes  to  diagnostics  is 
limited. 

The  intensity  (depth)  of  the  respirations  is  not  marked 
in  healthy  animals  standing  at  rest.  The  alae  of  the  nostrils 
are  hardly  moved,  and  the  ribs  but  slightly  raised.  The 
intensity  is  i  n  c  r  e  a  s  e  d  by  exercise ;  if  it  is  augmented 
and  the  animal  at  rest,  it  denotes  disease.  Horses  dilate  the 
nostrils  trumpet-like,  dogs  open  the  mouth  (pant)  and  pro- 
trude the  tongue.  The  movements  of  the  ribs  and  flanks  are 
pronounced.  The  development  of  the  intensity  agrees  with 
the  degree  of  dyspnea. 

The  intensity  is  diminished  when  the  pleura, 
chest  wall  or  diaphragm  is  diseased. 

The  intensity  can  become  asymmetrical 
in  that  one  side  of  the  thorax  undergoes  a  deeper  or  more 
rapid  movement  than  the  other  side.  This  is  seen  in  painful 
unilateral  pneumonias  or  pleurites. 

Wlien  the  rhythm  and  intensity  of  breathing  is  normal 
and  the  ribs  and  abdomen  are  moved  with  even  regularity,  the 
type  of  the  respirations  is  spoken  of  as  costo-ahdominal. 
If  the  respiratory  movements  are  produced  principally  by  the 
auxiliary  muscles  of  breathing,  which  dilate  the  thorax,  the 
type  becomes  costal.  The  costal  type  is  seen  to  occur  where 
air  can  not  pass  freely  into  the  thorax  or  where  the  diaphragm 
or  adjacent  organs  are  diseased,  (abdominal  tumors,  ascites, 
tympanitis). 

When  the  abdominal  muscles  are  more  active  in  produc- 
ing the  respiratory  movement  than  the  thoracic  muscles  the 
type  of  breathing  becomes  abdominal.  The  abdominal 
type  prevails  when  painful  conditions  of  the  chest  wall  are 
present  and  where  expiration  is  difficult,  as  in  pulmonary 
emphysema  (heaves). 

T'here  is  sometimes  observed  in  animals  a  condition  which 
corresponds  to  hiccoughs  (singultus)  in  man.  It  is  charac- 
terized by  a  rhythmic,  spasmotic  contraction  of  the  diaphragm 


94  CLINICAL    DIAGNOSTICS. 

(abdominal  pulsation)  with  which  a  jerky  movement  of  the 
thorax  in  the  hypochondriac  region  occurs.  Occasionally  it 
is  accompanied  by  a  dull  sound.  Its  rhythm  is  synchronous 
with  neither  the  heart's  beat  nor  the  respirations.  The  latter, 
however,  are  temporarily  arrested  by  the  spasms.  Singultus 
is  usually  temporary  and  probably  due  to  a  diaphragmatic 
neurosis. 

Respiratory  Sounds. 

The.  respirations  of  healthy  animals  are  performed  noise- 
lessly. Only  occasionally  do  they  voluntarily  emit  audible 
sounds  during  the  act  of  breathing. 

Physiological  Sounds.  When  excited  suddenly  by 
perceiving  peculiar  looking  objects,  strange  persons,  unaccus- 
tomed odors,  etc.,  horses  and  cattle  snort  by  violently  and 
noisily  forcing  air  through  the  dilated  nostrils.  Horses  of 
lively  temperament  usually  snort  when  led  at  the  end  of  the 
halter.  Horses  blow  their  noses  by  causing  a  forced  expira- 
tion which  is  accompanied  by  a  vacillating  noise.  As  in  man, 
du:*t  or  mucus  is  thus  removed  from  the  nasal  organs.  Fat, 
rough  coated  dogs  pant  when  the  weather  is  warm  even  when 
they  are  at  rest.  While  performing  hard  work  or  during 
forced  exercise  the  breathing  is  rapid  and  deep ;  the  air  pass- 
ing in  and  out  of  the  dilated  nostrils  at  each  in-  and  expiration 
produces  a  perceptible  puffing  sound.  Spirited  horses  while 
being  ridden  at  a  gallop,  emit  a  blowing  expiratory  sound . 
every  time  the  forefeet  come  in  contact  with  the  ground. 

A  yazvn  is  a  long-drawn-out,  deep  inspiration  taken  with 
the  mouth  held  icidc  open.  The  inspiratory  muscles  assist  in 
producing  it. 

Pathological  Sounds.  When  the  respiratory  apparatus 
is  diseased  the  following  p  a  t  h  o  1  o  g  i  ca  1  sounds  mav 
occur : 

1.  The  zi'hcccing  or  blozving  sound  which  is  stenotic  in 
its  character,  emanates  from  the  nasal  cavities.     It  is  more 


RESPIRATORY   APPARATUS.  95 

pronounced  at  inspiration,  and  results  from  a  narrowing  of 
the  nasal  chambers  due  to  the  presence  of  tumors,  swelling 
of  the  alae  of  the  nostrils,  septum  or  chonchae,  enlargements 
of  the  turbinated  bones  or  fractures  of  these  bones,  fractures 
of  the  nasal  bones,  or  deposits  of  exudate  on  the  mucous 
membrane.  Depending  upon  the  condition  of  the  mucous 
membrane,  the  stenotic  sound  may  be  accompanied  by  either 
moist  or  dry  rattling  noises. 

2.  Snoring  takes  place  when  the  act  of  breathing  is  ef- 
fectednhrough  the  open  mouth,  the  soft  palate  undergoing  .a 
fluttering  motion.  In  swine  and  dogs  it  occurs  when  the 
lumen  or  the  nasal  cavities  is  contracted  by  swelling  or  thick- 
ening of  the  mucous  membrane.  Snoring  is  also  noted  in  the 
ox  when  the  retro-pharyngeal  lymph  glands  are  swollen  or 
enlarged ;  further  in  the  course  of  parturient  paresis.  Horses 
under  chloroform  sometimes  snore. 

3.  Rattling  is  a  stenotic  laryngeal  sound  which  occurs 
when  the  vocal  cords  are  relaxed.  It  is  heard  in  severe  in- 
flammations of  the  larynx  or  of  the  neighboring  pharyngeal 
mucous  membrane;  phlegmon  of  the  pharynx  and  edema  of 
the  glottis. 

4.  "The  Mucous  Click"  {klatschcndcr  Xasalton)  is  a 
peculiar  metallic,  short  expiratory  sound  first  described  by 
Dieckerhofif.  It  occurs  during  an  inspiratory-expiratory  dys- 
pnea if  the  nasal  mucous  membrane  is  very  moist.  At  a 
forced  inspiration  that  part  of  the  nasal  mucous  membrane 
which  unites  w^ith  the  skin  of  the  false  nostril,  is  sucked 
against  the  opposite  wall  to  which  it  adheres  for  a  moment; 
when  an  expiration  takes  place  this  adhesion  is  broken,  caus- 
ing a  metallic  "slapping"  tone  to  be  emitted.  This  sound  is 
of  no  significance. 

5.  The  most  important  pathological  re- 
spiratory t  o  n  e  is  the  stenotic  laryngeal  tone.  Normally 
the  sound  emitted  by  the  larynx  is  a  soft  stenotic  sound  audi- 
ble when  the  ear  is  placed  bver  the  organ.     [It  can  be  imitated 


»D  CLINICAL    DIAGNOSTICS. 

by  pronouncing  the  German  "ch"].  If  the  lumen  of  the  lar- 
ynx is  narrowed,  the  noise  becomes  loud.  It  is  most  fre- 
quently heard  in  the  horse,  and  is  one  of  the  characteristic 
symptoms  of  roaring. 

Ordinarily  the  tone  is  emitted  when  the  respirations  are 
accelerated  during  exercise,  but  in  cases  where  the  lumen  of 
the  larynx  is  much  diminished,  it  may  appear  when  the  patient 
is  at  rest. 

The  character  of  the  tone  will  vary  from  ichistliiig  to  a 
pronounced  hoarse  or  roaring  sound. 

Besides  it  may  be  due  to  a  firm  swelling  of  the  laryngeal 
mucous  membrane  (phlegmonous  laryngitis,  strangles),  tu- 
mors in  the  larynx  or  its  neighborhood  which  prevent  the 
free  entrance  of  air. 

6.  Loud  rattling  noises  [garglings]  are  heard  when  the 
larynx  or  the  trachea  contains  loose  masses  of  mucus. 

7.  S)icc::ing  is  an  explosive  expiration  through  the  nose, 
which  originates  reflexly  from  irritations  to  the  nasal  mucous 
membrane.  It  is  heard  in  rhinitis  (nasal  catarrh)  or  when 
foreign  bodies  enter  the  nasal  cavities.  Sneezing  only  occurs 
in  the  dog,  cat,  and  fowl. 

8.  Groaning  (moaning,  grujiting)  is  heard  when  a  long 
inspiration  is  followed  by  a  prolonged,  audible  expiration 
through  a  partially  closed  glottis.  The  sound  is  emitted  only 
at  expiration.  Groaning  is  not  necessarily  a  sign  of  disease, 
for  it  often  occurs  in  healthy  animals,  especially  cattle  after 
a  full  feed  or  when  pregnant.  Groaning  is  produced  by  the 
pressure  of  the  distended  abdominal  organs  upon  the  dia- 
phragm, shortening  the  expiratory  moment,  which  the  animals 
seek  to  retard  by  partially  closing  the  glottis. 

d.     Labored  Breathing,  Dyspnea. 

The  collective  term  dyspnea  is  applied 
to  essential  deviations  from  the  normal  in 
the  frequency  and  kind  of  respiratory  move- 


RESPIRATORY  APPAR.\TUS.  97 

ments,  and  the  occurrence  of  accompany- 
ing pathological  sounds. 

Physiologically  a  dyspnea  occurs  whenever  the  blood 
blowing  through  the  respiratory  center  contains  an  abnormal 
amount  of  CO.,.  Accordingly,  anything  which  increases  the 
quantity  of  CO.  in  the  tissues,  or  interferes  with  the  exchange 
of  gases  in  the  lungs,  can  cause  a  dyspnea. 

Clinically  the  presence  of  dyspnoea  is  recognized : 

I.  If  the  respirations  are  accelerated  (altered  in 
number  ) ,  and  the  increased  frequency  is  not  attended  with 
■change  in  the  method  of  breathing  the  dyspnea  is  simple. 

In  the  horse,  for  instance,  the  number  of  respirations  can 
exceed  120  per  minute  and  be  superficial,  only  the  nostrils 
becoming  dilated.  If,  however,  the  respirations 
arevery  difficult,  it  ceases  tobe  simple  dysp- 
nea, for  the  method  of  breathing  becomes  more  intensive 
and  labored,  and  the  dyspnea  mixed. 

Simple  dyspnea  appears : 

1.  In  fever;  the  degree  of  respiratory  frequency  de- 
pends upon  the  severity  and  nature  of  the  disease. 

2.  In  all  conditions  which  make  the  respirator v  act 
painful :  diseases  of  the  pleura,  diaphragm,  thoracic  wall, 
peritoneum. 

3.  Where  the  breathing  surface  of  the  lung  is  decreased 
or  where  the  organ  is  prevented  from  properly  expanding: 
pneumonia,  pulmonary  tuberculosis,  abdominal  tympanitis, 
ascites, 

■i.  In  diseases  of  the  heart  which  have  a  congestion  of 
the  blood  in  the  lungs  as  a  consequence. 

II.  If  the  respirations  are  labored  (alteredin  qual- 
ity )  ,  though  the  frequency  may  be  normal,  aggravated  dysp- 
nea. The  occurrence  of  respiratory  noises 
always  indicates  a  difficulty  in  breathing. 
Depending  upon  whether  the  expiration  or  inspiration  is  dif- 
ficult, an   expiratory  or  inspiratory  dyspnea  is   distinguished. 


98  CLINICAL    DIAGNOSTICS. 

The  inspiratory  dyspnea.  If  the  entrance  of 
air  into  the  respiratory  organs  is  made  difficult,  the  animal 
seeks  to  overcome  the  condition  by  taking  forced  inspirations. 
N  o  t  o  n  1  y  i  s  t  h  e  d  i  a  p  h  r  a  g  m  a  c  t  i  V  e  1  y  e  m  p  1  o  >'  e  d, 

b  u  t  o  t  h  e  r  m  u  s  c  1  e  s  w  h  i  c  h  a  r  e  n  o  r  m  a  1 1  \-  n  o  t  u  s  e  d 
during  inspiration  are  called  into  play. 
These  muscles  are:  the  serratus  magnus,  serratus  anticus,. 
external  intercostals,  levatores,  costarum,  scalenus.  The 
following  clinical  s  }•  m  p  t  o  m  s  character- 
ize   dyspnea: 

The  nostrils  are  widely  distended;  dogs,  fowls,  cattle  and 
swine  breathe  with  their  mouths  open.  Dogs  sometimes  close 
the  jaws  and  breathe  through  the  lateral  commissures  of  the 
mouth,  sucking  in  the  cheek  at  each  inspiration.  The  head 
and  neck  are  extended  horizontally,  the  larynx  is  retraced,  the 
ribs  greatly  elevated  and  rolled  forward.  The  forelimbs  are 
spread  far  apart  and  the  elbows  turned  out  so  that  the  serrati 
and  pectoral  muscles  can  better  come  into  play. 

If,  in  aggravated  inspiratory  dyspnea,  the  air  enters  the- 
lung  very  slowly,  notwithstanding  that  the  ribs  are  greatly 
elevated,  and  the  thorax  is  distended  to  a  degree  which  does 
not  correspond  to  the  quantity  of  air  passing  in,  a  suction 
pressure  will  occur,  which  can  be  recognized  by  a  sinking  of 
the  lozvcr  anterior  thoracic  zvall — particularly  of  its  inter- 
costal spaces. 

Inspiratory    dyspnea     is    observed: 

1.  In  a  pure  form  in  bilateral  paralysis  (paraplegia)  of 
the  larynx  and  in  severe  cases  of  unilateral  paralysis  of  the 
organ  (hemiplegia,  roaring).  It  is  characterized  by  the  above 
cited  inspiratory  dyspnea  and  the  appearance  of  a  stenotic 
laryngeal  bruit.  In  less  severe  cases  of  roaring  this  symp- 
tom can  only  be  brought  out  by  exercising  the  patient.  The- 
act  of  expiration  is  performed  without  difficulty. 

2.  In  less  pure  form  where  a  stenosis  of  the  nasal  pas- 


RESPIRATORY   APPARATUS.  99 

sages,  pharynx,  larynx  or  trachea  exists  due  to  inflammatory 
swelhngs,  tumors,  etc.  In  such  cases  a  stenotic  sound  is 
emitted  at  each  inspiration  and  the  expiration  is  more  or  less 
difficult. 

3.  In  diseases  of  the  bronchi  and  lungs  preventing  the 
free  entrance  of  air:  bronchitis,  pulmonary  edema,  pneu- 
monia. 

■i.  ^^'here  the  principal  respiratory  muscle,  the  dia- 
phragm, is  inactive :  rupture  or  inflammation,  tympanitis. 

Expiratory  dyspnea.  This  occurs  when  the 
exit  of  the  air  from  the  lung  is  made  difficult.  In  this  case 
the  expiration  ensues  not  alone  passively,  but  the  accessory 
expiratory  muscles  a  c  t  i  v  e  1  \-  assist.  The 
muscles  aiding  expiration  are:  the  abdominal  muscles  (exter- 
nal and  internal  oblique,  straight  abdominal  muscle),  the  in- 
ternal intercostals  and  triangularis.  An  expiratory 
dyspnea  is  recognized  by  the  following 
s  y  m  p  t  o  m  s  :  The  expiration  js  prolonged  and  is  attended 
with  pronounced  movement  of  the  abdominal  wall  (pui)ipiiig 
of  the  flanks).  At  first,  a  limited  sinking  of  the  thoracic  walls 
■ensues  from  a  relaxation  of  the  diaphragm,  then  the  abdominal 
muscles  become  active  (contract)  and  a  furrow  is  formed 
along  the  course  of  their  insertion  to  the  costal  cartilages — 
the  so-called  "heave  line."  The  passive  and  active  moments 
of  expiration  can  be  plainly  distinguished  from  each  other,  so 
that  the  movement  of  the  flank  appears  to  be  a  double  pump- 
ing. The  back  is  elevated  at  expiration  and  sinks  during 
inspiration.  At  the  moment  of  expiration  the  anus  is  greatlv 
protruded.  When  the  abdomen  is  well  filled,  these  symp- 
toms appear  more  prominentl\-. 

Expiratory  dyspnea  occurs : 

1.  In  vesicular  and  interstitial  emphysema. 

2.  In    chronic    bronchitis    and    peri-bronchitis. 

3.  Where  the  lung  has  adhered  to  the  costal  wall. 

A    mixed     dyspnea    is    present    when    accelerated 


100  CLINICAL    DIAGNOSTICS. 

respiratory  frequency  is  combined  with  difficult  inspiration 
and  expiration  (inspiratory  and  expiratory  dyspnea).  It  is 
the  most  common  form  of  dyspnea  and  attends  all  severe 
diseases  of  the  respiratory  tract  (pneumothorax,  hydrothorax) 
and  also  those  diseases  which  have  no  primary  seat  but  whose 
course  is  accompanied  by  a  severe  intoxication  of  the  blood 
with  COo — as  in  many  of  the  infectious  diseases. 

In  pronounced  mixed  dyspnea  there  is  a  marked  flap- 
ping of  the  nostrils.  At  the  beginning  of  inspiration  both 
wings  (medial  and  lateral)  are  greatly  distended.  At  the 
end  of  the  inspiratory  movement  they  again  collapse.  How- 
ever, the  forced  out-flow  of  air  at  expiration,  which  imme- 
diately follows,  forces  the  medial  wing,  which  is  in  its  path, 
outward  and  upward  causing  a  second  movement  of  this 
wing  to  occur. 

According  to  the  seat  of  the  respiratory  obstruction  one 
speaks  of  a  nasal,  laryngeal,  tracheal  and  pulmonary  dysp- 
nea. 

II.     The  Breath. 

An  examination  of  the  air  breathed  out  by  the  lungs  is 
of  diagnostic  importance  in  many  morbid  conditions.  Xor- 
mally  the  air  is  emitted  from  the  nostrils  in  two  odorless  cur- 
rents of  equal  size.    The  two  deviations  from  the  normal  are : 

1.  The  air  currents  from  both  nostrils  are  not  of  equal 
size.  Where  one  of  the  currents  is  smaller  (of  less  volume) 
than  the  other,  it  points  to  a  narrowing  of  the  nasal 
passage  of  that  side.  Xot  infrequently  a  blozcing  sound 
accompanies  the  inspiration.  The  passages  may  be  con- 
stricted by  thickenings  or  swellings  of  the  mucous  membrane 
or  by  tumors. 

2.  The  breath  has  a  bad  odor.  A  bad  odor  from  the 
nostrils  is  always  a  sign  that  putrid  decomposition  is  taking 
place  in  the  air  passages.  It  may  emanate  from  various  parts 
of  the  respiratory  tract.  The  odor  is  either  putrid  {fetid} 
or  carious.    It  is  observed: 


RESPIRATORY   APPARATUS.  IQl 

1.  Where  stagnant  masses  of  putrefying  exudate  are  in 
the  turbinated  bones,  sinuses,  gutteral  pouches,  or  even  on  the 
mucous  membrane  of  the  upper  air  passages  and  bronchi. 

2.  In  putrid  decomposition  of  tumors  in  the  air  passages. 

3.  In  suppuration  or  necrosis  of  the  bones  of  the  h*^ad 
bordering  on  the  air  passages:  Suppuration  in  the  tooth 
alveoh.  dental  caries,  necrosis  of  the  turbinated  bones. 

4.  In  gangrene  of  the  hmgs. 

It  is  always  important  to  determine  where  the  odor 
originates.  At  first  we  should  be  clear  as  to  whether  it 
really  comes  from  the  nose  or  from  the  mouth.  When  the 
mouth  is  closed,  this  is  usually  not  difficult ;  in  doubtful  cases 
the  odor  of  the  saliva  can  be  tested.  The  safest  way  is  to 
make  an  examination  of  the  buccal  cavity,  especially 'of  the 
teeth.  Wlien  the  alveoli  of  the  upper  molars  are  diseased,  a 
carious  smell  is  emitted  from  both  the  mouth  and  nose.  (See 
Examination  of  the  Mouth). 

If  the  offensive  odor  has  been  found  to  come  from  the 
expiredair,itis  then  necessary  to  locate  the  part  of  the 
respiratory  apparatus  at  which  the  decomposition  is  taking 
place.  For  this  purpose  we  should  first  determine  whether  or 
not  the  odor  is  equally  offensive  from  both  nostrils.  When 
the  odor  from  one  nostril  is  more  prevalent  than  from  the 
other,  the  process  of  decomposition  has  its  seat  in  the  nasal 
cavity  of  that  side,  and  usually  it  is  accompanied  by  a  unilat- 
eral nasal  discharge,  bulging  of  the  facial  bones  and  swelling 
of  the  submaxillary  lymph  glands. 

The  examination  of  the  upper  molar  teeth  of  that  side 
should  never  be  neglected. 

When  the  odor  is  equally  oft'ensive  from  either  nostril, 
the  putrid  focus  is  as  a  rule  contained  in  the  lung,  more  rarely 
in  the  pharynx,  larynx  or  trachea. 

Putrid  decomposition  in  the  lung  is  not 
always  to  be  ascribed  to  pulmonary  gan- 
grene,    for    not     infrequently    adecomposi- 


102  CLINICAL    DIAGNOSTICS. 

tion  of  exudate  in  the  bronchi,    (fetid  bronchitis) 
is  present. 

The  presence  of  elastic  fibres  in  the  nasal  discharge 
speaks   for  pulmonary  gangrene. 

III.     Nasal   Discharge. 

Only  in  the  ox  a  slight  nasal  discharge  is  seen  to  occur 
in  health,  which  the  animal  usually  removes  from  the  nostrils 
with  its  tongue.  In  the  other  animals  the  appearance  of  a 
nasal  discharge  is  always  a  sign  of  disease,  and  one  of  con- 
siderable diagnostic  importance.  It  can  accompany  all  dis- 
eases of  the  respiratory  tract  which  are  exudative  in  char- 
acter, such  as  catarrhs  of  the  nasal  cavities,  sinuses  of  the 
head,  throat,  larynx,  trachea,  bronchi  and  lungs.  In  these 
'  cases  the  discharge  is  the  product  of  the  disease.  Some- 
times the  discharge  comes  from  the  digestive  tract,  from  the 
mouth  or  pharynx,  more  rarely  from  the  gullet  or  stomach, 
when  it  contains  substances  such  as  food  particles,  water  or 
saliva. 

The  character  of  the  nasal  discharge  depends  upon  the 
organ  from  which  it  comes  and  the  nature  of  the  disease  pro- 
ducing it.  We  should  bear  in  mind  that  the  ox,  sheep,  goat 
and  dog  usually  lick  ofif  the  discharge,  hence  it  is  not  so 
noticeable  in  these  animals  as  in  the  horse. 

■   To  correctly  judge  nasal  discharge  the  following  should 
be  considered : 

a.  The  quantity,  which  will  vary  greatly.  The  dis- 
charge is  slight  in  catarrhs  that  are  neither  very  dififuse  nor 
severe.  In  tuberculosis,  notwithstanding  the  severity  of  the 
case,  there  is  little  discharge  because  what  little  exudate 
appears  upon  the  surface  of  the  mucous  membranes  is  re- 
moved by  coughing  and  eventually  swallowed. 

The  discharge  is  copious  in  strangles  and  in  dififuse 
catarrhs  of  the  upper  air  passages  and  bronchi. 

Unilateral  nasal  discharge  is  characteristic  of  disease  of 
one  side  of  the  anterior  air  passages  as  far  back  as  the  fauces. 


RESPIRATORY   APPARATUS.  103 

A  catarrh  involving  but  one  side  of  the  soft  palate  or  pharynx 
may  also  show  a  discharge  from  only  one  nostril. 

Of  especial  importance  is  the  varmtion  in  quantity  of  the 
discharge.  In  some  cases  a  copious  amount  of  discharge  is 
ejected  when  the  head  is  suddenly  lowered  [unreining  after  a 
drive],  while  for  a  day  or  more  there  is  present  either  no  dis- 
charge at  all  or  only. a  very  slight  one.  This  symptom  is 
characteristic  of  catarrhs  of  the  frontal  and  superiormaxii- 
lary  sinuses  and  of  the  guttural  pouches. 

b.  The  color.  The  color  of  the  nasal  discharge  de- 
pends upon  the  character  of  the  inflammation,  and  also  the 
presence  of  foreign  mixtures.  It  will  vary  from  colorless  to 
grey,  zi'kite,  yellow,  red,  brown  or  green  in  all  their  different 
tints.  During  the  course  of  a  disease  the  color  of  the  nasal 
discharge  will  change  with  the  character  of  the  inflamma- 
tion. A  serous  or  mucous  discharge  is  usually  colorless;  a 
purulent  discharge  is  grey  or  yellow  or  may  be  of  a  greenish 
hue. 

A  green  discharge  is  usually  due  to  an  admixture  of  the 
chlorophyll  of  the  food,  deglutition  being  difficult.  Food 
particles  are  always  present  in  such  cases.  In  rare  instances 
a  greenish  tinge  is  seen,  due  to  decomposed  blood  coloring 
matter  being  present  in  the  discharge. 

A  yellozv,  rust-colored  ["prune  juice"]  discharge  is  seen 
m  hemorrhagic  hepatization  of  the  lungs  (contagious  pleuro- 
pneumonia of  the  horse).  It  is  due  to  an  admixture  of  blood 
coloring  matter. 

In  rare  instances  a  rusty  brown  nasal  discharge  is  pres- 
ent m  severe  catarrhal  afifections  of  the  anterior  respiratory 
passages   (strangles,  pharyngitis). 

A^  bloody  discharge  {cpistaxis)  is  observed  onlv  when 
blood  in  toto  is  present.     It  may  be  due  to: 

1.  Finger-nail  injuries  to  the  mucous  membrane  of  the 
nose  or  fractures  of  nasal  bones.  In  the  dog  the  presence 
of  pentastomum  tenioidcs  may  lead  to  bloody  nasal  discharge, 
and  in  sheep  the  larvae  of  oestrus  ovis. 


104  CLIXICAL    DIAGNOSTICS. 

2.  Ulcers ;  glanders ;  bleeding  tumors  in  the  nasal  cavi- 
ties. 

3.  Nasal  hemorrhages  may  attend  anthrax  in,  the  ox, 
purpura  hemorrhagica,  or  very  severe  cases  of  contagious 
pleuropneumonia  of  the  horse. 

The  discharge  may  consist  entirely  of  blood,  or  simply 
of  an  admixture  of  blood.  If  the  hemorrhage  is  from  a 
nasal  cavity,  it  is  unilateral,  the  blood  appeafs  fresh  and  in- 
completely mixes  with  any  other  discharge  present.  If  from 
the  lungs,  it  is  more  or  less  foamy  and  in  the  trachea  one 
may  hear  moist  rales. 

c.  The  consistency  of  the  nasal  discharge  depends 
upon  what  it  contains.  It  may  be  serous,  mucous  or  mucil- 
aginous, with  varied  intermediations.  It  may  also  be  Hoccn- 
lent,  clumpy,  or  contain  great  masses  of  adhering  exudate. 
In  the  beginning  of  a  catarrh  the  discharge  is  serous  (clear), 
but  by  admixtures  of  mucus  it  becomes  mucous  and  loses  its 
transparency  from  the  quantity  of  epithelial  cells  it  contains. 
Its  color  is  then  grey.  When  an  admixture  of  pus  is  present 
the  discharge  assumes  more  of  a  cream-like  consistency  and 
its  color  changes  to  greyish-yellow  or  yellow.  A  discharge  of 
pure  pus  only  occurs  when  an  abscess  ruptures  into  the  nasal 
cavity. 

A  clump}',  b  u  1 1  e  r  m  i  1  k  -  li  k  e  discharge  is 
observed  in  chronic  catarrh  of  the  sinuses  of  the  head  because 
the  exudate  has  been  retained  for  a  time. 

Adhering  masses  of  exudate  are  seen  in  diph- 
theritic, croupous,  or  fibrinous  inflammations. 

d.  The  odor.  ,  The  odor  of  the  nasal  discharge  be- 
comes fotil,  putrid  or  carious  from  decomposing  processes. 
In  such  cases  the  breath  is  also  tainted.  For  the  determin- 
ation of  the  seat  of  the  disorder,  what  has  been  said  concern- 
ing the  odor  of  the  expired  air  applies. 

e.  Foreign  admixtures.  Most  commonly  we  observe 
air  bubbles  of  large  or  small  size  which  cause  the  discharge 

to  appear   as   foam. 


RESPIRATORY   APPARATUS.  105 

Fine  foam.  When  the  discharge  comes  from  the  smaller 
bronchi  in  pulmonary  edema  and  bronchitis,  the  foam  is 
composed  of  small  air  bubbles  of  equal  size.  When  there  is 
much  foam  the  discharge  is  white  in  color.  Horses  suffering 
from  chronic  bronchial  catarrh  after  exercise  show  a  white 
nasal  discharge  partially  made  up  of  fine  foam. 


Fig.  28.    Egg  of  r  .  ■„.  ,  -iium  Tenioides. 

Coarse  foam.  This  is  not  infrequently  unilateral  and 
contains  an  admixture  of  food  particles.  It  comes  from  the 
mouth  and  consists  in  part  of  saliva.  The  air  bubbles  are 
of  unequal  size.  Coarse  foam  is  symptomatic  of  paralysis 
of  the  pharynx,  pharyngitis    (fungus  poisoning). 

When  food  particles  alone  make  up  the  nasal  dis- 
charge, it  is  a  sign  that  vomiting  has  taken  place.  The  dis- 
charge is  then  not  foamy,  is  of  acid  reaction  and  contains  no 
admixtures  of  exudate. 

A  microscopical  examination  of  the  nasal 
discharge  is  rarely  of  practical  value.  It  may  sometimes  be 
of  use  to  determine  the  presence  of  the  embryo  or  egg  of 
Strongylus  filaria  in  the  lungs  of  sheep  or  of  Pentastomum 
taenioides  in  the  nasal  passages  of  the  dog,  or  in  fetid  nasal 
discharge,  the  elastic  fibres. 

The  examination  for  pathogenic  micro- 
organisms yields  positive  results  only  in  exceptional  cases. 
The  tubercle  bacilli  are  one  of  these  exceptions  as  their  char- 
acteristic way  of  accepting  stains  serves  to  identify  them 
microscopically. 

Microscopical  determination  of  tubercle  bacilli.     A  cover-glass 
preparation    is    covered    with    Ziehl's    carbolized-fuchsin    solution 


106  CLINICAL    DIAGNOSTICS. 

(fuchsin  1,  absolute  alcohol  10,  carbolic  acid  5,  aq.  dist.  95),  and 
heated  repeatedly  for  about  two  minutes  over  a  flame.  Wash 
and  drain.  Gabbet's  solution  (methylen  blue  2.  in  100  grammes  of 
a  25%  sulphuric  acid)  is  then  applied  and  allowed  to  remain  Yi 
minute.     Wash  and  examine. 

Fig.  29. 


) 


'    '^-^i- 


Tubercle  bacilli. 


_  Besides    the    tubercle    bacillus,    other    bacilli      (acid-fast),   which 
stain  by  .this  method,  are  found  in  the  feces  of  cattle  and  in  butter. 

IV.     The    Nasal    Cavities    and   Adjacent    Sinuses. 

The  external  appearance  of  the  facial  bones  will  readily 
betray  any  deformity.  Circumscribed  enlargements  are 
due  to  tumors  and  a  bulging  of  the  sinuses  in  chronic  catarrhs. 
Diffuse  enlargements  attend  rachitis  and  osteoporosis,  "big 
head."  Depressions  have  a  traumatic  origin.  Swellings 
appearing  at  the  nasal  openings  and  nostrils  are  common  in 
purpura  hemorrhagica.  Tumors  (atheromas)  are  frequent 
in  the  false  nostril. 

The  specific  pathological  conditions 
which  occur  about  the  lips  and  nose  are  the  pustules  and 
ulcers  which  attend  contagious  stomatitis,  the  pox  pustules  of 
sheep  pox,  and  the  vesicles  on  the  muzzle  of  the  ox  and  snout 
of  swine  suffering  from  foot  and  mouth  disease. 

When  a  nasal  discharge  has  existed  for  a  long  time,  the 
integument  of  the  nose  and  lips  over  which  it  flows  loses  its 


RESPIRATORY   APPARATUS. 


107 


pigment.      The   white     streaks     thus     formed    speak    for   the 
chronicity  of  the  dischargee. 

The  examination  of  the  nasal  mucous  membrane.  The 
nasal  mucous  membrane  is  available  to  inspection  only  in 
the  horse.  Local  lesions  occurring  on  it  are  often  of  great 
diagnostic  importance. 

Method  of  examination.  The  head  of  the  animal  should  be 
elevated  "and  the  inner  cartilaginous  wing  of  the  nostril  grasped 
between  the  thumb  and  middle  finger  which  draws  it  upward  and 
outward;  the  extended  index  finger  is  then  inserted  under  the 
outer  wing,  which  it  distends.  The  patient  should  face  the  light, 
axcept  when  the  rhinoscope  (an  enlarged    ophthalmoscope)   is  used. 


Examination  of  the  Mucous  Membrane. 

a.  Discolorations.  Iiidistiiicf.  puiictifonii,  or  rauiiform 
redness  is  not  infrequently  seen  in  acute  and  chronic  catarrhs ; 
they  are  due  to  the  peculiar  anastomosing  of  the  capillaries 
and  are  of  no  diagnostic  value. 

Deep  redness  is  mostly  the  result  of  hemorrhages  in  the 
mucous  membrane.  They  appear  mostly  punctiform  and  can 
be  as  large  as  a  ten-cent  piece,  they  are  well  circumscribed 
and  of  round  form    (petechiae,   ecchymoses).       When    they 


108  CLINICAL    DIAGNOSTICS. 

become  confluent,  the  redness  is  diffuse  or  appears  in  irregular 
streaks.  Petechiae  are  most  commonly  seen  in  purpura 
hemorrhagica,  but  may  also  occur  in  severe  anemia 
(rare)  and  in  leucemia.  The  spots,  which  are  at  first  dark 
red,  soon  fade  and  assume  a  brownish  hue.  Such  suffusions 
are  also  observed  in  septicemic  diseases:  anthrax,  septicemia. 

b.  Swelling  of  the  nasal  mucous  mem- 
brane is  characterized  by  the  normal  surface  of  the  mucous 
membrane,  which  is  granular  from  the  many  glands  it  con- 
tains, becoming  firm  and  smooth.  As  the  membrane  is 
usually  tense,  the  swelling  is  not  marked.  Its  origin  is  in- 
flammation, therefore  the  surface  appears  turbid. 

Chronic,  connective  tissue  thickenings 
are  most  commonly  made  manifest  by  irregular,  wart-like 
prominences  which  show  the  characteristics  of  scars. 

c.  Wounds  in  the  mucous  membrane  are  usu- 
ally at  the  lowest  part  of  the  septum,  and  are  very  often 
caused  by  finger-nails,  sharp  straws  and  the  like. 

d.  Nodules  from  the  size  of  a  millet  seed  to  that  of  a 
peppercorn  almost  exclusively  attend  glan- 
ders. Exceptionally  they  result  from  contagious  stomatitis, 
but  in  such  cases  like  nodules  are  to  be  found  in  the  mucous 
membrane  of  the  mouth.  To  prevent  mistaking  particles  of 
mucus  for  true  nodules,  the  supposed  nodule  should  be  pal- 
pated with  the  finger ;  if  mucus  particles,  we  can  thus  wipe 
them  off. 

e.  Ulcers,  N  ex  tto  nodules,  ulcers  form 
the  most  important  c  r  i  t  e  r  i  u  m  in  diag- 
nosing glanders.  Glanders  ulcers  have  jagged  bor- 
ders circumscribed  by  rounded,  elevated  walls.  The  base  of 
the  ulcer  is  sunken,  uneven,  grey  in  color,  and  of  lardaceous 
appearance.  The  favorite  seat  of  the  glanders  ulcer  is  on  the 
medial  border  of  the  inner  cartilaginous  wing  of  the  nostril, 
hence 'this  place  should  always  be  examined. 

In  rare  cases  ulceration  of  the  nasal  mucous  membrane 


RESPIRATORY   APPARATUS.  109 

also  attends  stomatitis  and  purpura  hemorrhagica.  For  dif- 
ferentiation tlie"  concomitant  symptoms  must  be  considered, 
such  as  ulcers  on  the  buccal  mucous  membrane,  petechiae,  etc. 

\"  e  r  y  superficial  p  i  1 1  i  n  g  s  with  sharp 
borders  —  not  rounded  nor  red  colored  —  represent  the 
catarrhal  or  erosion  ulcer. 

f.  Cicatrices  at  the  lower  end  of  the  nasal  septum 
are  mostly  the  result  of  previous  wounds.  They  are  often 
curved  ( (  as  if  made  with  a  finger-nail.  Glanders  cicatrices 
are  as  a  rule  more  or  less  star-shaped. 

The  examination  of  the  sinuses  of  the  head  is  often 
of  importance  and  should  be  made  whenever  a  chronic  nasal 
discharge  exists,  especially  when  attended  with  an  unilateral 
bulging  (enlargement)  of  the  facial  bones.  Mere  enlarge- 
ments can  be  defined  by  palpation.  The  presence  of  exu- 
dates in  the  sinuses  can  sometimes  be  determined  by  percus- 
sion. The  normal  percussion  sound  of  the  sinuses  is  full,  but 
when  they  are  filled  with  exudate  or  tumor  masses,  it  becomes 
fiat.  \\^hen  the  sinuses  are  only  partially 
filled  the  percussion  Sound  is  not  changed. 
Negative  results  from  percussion,  therefore,  do  not  exclude 
the  presence  of  exudate. 

[A  simple  method  of  exploring  the  sinuses  of  the  head, 
to  determine  whether  exudate  (pus)  is  present  in  them  or  not, 
is  to  bore  a  small  hole  into  them  with  a  "Yankee"  drill.  If  the 
sinuses  contain  pus  or  other  exudate,  the  bit  becomes  soiled 
by  it  and  if  the  contents  are  fetid,  will  smell] 

V.     The  Submaxillary  Lymph  Glands. 

Although  these  glands  do  not  properly  belong  to  the 
respiratory  apparatus,  the  examination  of  them  is  significant 
in  the  horse.  In  this  animal  especially,  the  glands  become 
sympathetically  diseased  when  pathological  conditions  exist 
within  the  domain  of  their  lymph  vessels. 


110  CLINICAL    DIAGNOSTICS. 

Anatomy.  The  lymph  vessels  from  the  nostrils  to  the  ethmoid 
bone  carry  their  lymph  to  the  submaxillary  glands,  a  small  glan- 
dular packet  as  broad  as  and  a  little  longer  than  a  finger,  lying 
on  each  side  of  the  intermaxillary  space.  They  begin  at  the  point 
where  the  inferior  maxillary  artery  passes  under  the  ramus  of  the 
lower  jaw,  and  extend  forward  to  the  angle  of  the  chin  where 
each  unites  with  its  fellow  of  the  opposite  side.  Each  lobule  is 
of  about  the  size  of  a  small  bean.  In  horses  of  coarse  conforma- 
tion the  intermaxillary  space  is  often  filled  without  the  glands 
being   swollen. 

As  soon  as  an  absorption  of  irritant  or 
infectious  substances  (bacteria]  tai-ces 
place  in  the  region  drained  b  }•  the  1 }'  m  p  h 
vessels  of  the  submaxillar}-  glands,  these 
organs  become  secondarily  diseased.  The 
primary  disease  usually  has  its  seat  in  the  mucous  membrane 
of  the  nasal  passages  or  sinuses.  An  examination  of  the 
glands,  therefore,  is  of  great  significance  in  determining  the 
pathological  condition  of  these  mucous  membranes. 

In  making  the  examination  the  following  points  are  to  be 
considered : 

a.  Is  one  o  r  both  g  1  a  n  d  s  e  n  1  a  r  g  e  d  ?  In  acute 
infectious  catarrhs  the  glandular  swelling  is  generally  bilat- 
eral; in  glanders  frequently  unilateral,  and  in  tumors,  in  the 
nasal  passages,  bad  teeth  and  chronic  catarrh  of  the  sinuses,  it 
is,  as  a  rule,  unilateral. 

b.  Size  and  form  of  the  glandular  s  \v  e  1 1  - 
i  n  g  .  Many  or  a  few  of  the  lobules  may  be  enlarged  to  the 
size  of  a  bean,  pigeon  or  hen's  tgg,  depending  upon  the  pri- 
mary disease  in  the  mucous  membranes.  Acute  swellings  are 
smooth;  chronic  swellings  lobulated  (nodular),  which  is  espe- 
cially marked  in  glanders. 

Well  marked,  clearly  defined,  smooth  enlargements  of 
individual  lobules  are  observed  in  leucemia  (a  hyperplasia), 
and  when  malignant  tumors  are  developing  in  the  glands. 

c.  Consistency  of  the  swollen  glands.  The 
swelling  is  soft  in  serous,  tense  and  firm  in  cellular  infiltration 
of  the  glands.    Acute  diffuse   swellings    (stran- 


RESPIRATORY   APPARATUS.  HI 

g  I  e  s  )  often  lead  to  suppuration  (ab- 
scess), which  can  be  determined  by  fluctiiation.  In 
glanders  diffuse  abscess  formation  never  occurs  in  the  glands; 
only  rarely  does  a  small  purulent  focus  (farcy  bud)  appear  in 
the  skin  over  the  gland.  Firm,  hard  enlargements 
are  always  due  to  some  chronic  irritation  and  consist  of  con- 
nective tissue  proliferations.  Such  attend  chronic  glanders, 
catarrhs  and  dental  fistulae. 

d.  Temperature  and  sensitiveness.  When 
the  glands  are  hot  and  tender  (inflamed),  the  morbid  con- 
dition is  acute  (strangles).  If  the  enlargement  of  the  gland 
is  firm,  cold  and  painless,  it  points  to  glanders,  chronic  catarrh, 
tumors  or  hyperplasias    [leucemia]. 

Movability  of  the  glands.  If  the  irritatiou 
is  chronic  and  attended  with  the  formation  of  new  connective 
tissue,  the  process  involves  the  environing  tissue,  forming  ad- 
hesions with  its  neighborhood.  In  acute  purulent  inflammation 
of  the  glands  there  develops  in  the  vicinity,  namely,  directly 
beneath  the  skin,  an  inflammatory  edematous  and  later  a 
phlegmonous  siveU'uig. 

The  extirpation  of  a  diseased  lymph  gland  is  recommended 
where  glanders  is  suspected.  Its  object  is  the  patho-anatomical 
or  bacteriological  examination  of  the  gland.  The  operation  can 
be  performed  on  the  standing  animal  when  local  anesthesia  is 
employed,  and  is  not  dangerous. 

VI.     Cough. 

Cough  is  a  suddenly  occurring  expi- 
ratory impulse  which  follows  a  deep  in- 
spiration. The  glottis  is  forcibly  opened 
during  the  act,  causing  a  sound  to  be 
emitted.  By  coughing  accumulations  of  mucus  are  re- 
moved from  the  bronchi,  trachea  or  lar_\  nx.  In  animals  cough, 
is  a  reflex  action  which  can  to  a  certain,  extent  be  suppressed. 
Although  it  can  be  induced  by  irritation  to  many  peripheral 
nerves,  as  a  rule  it  emanates  from  branches  of  the  vagus  nerve 


112  CLINICAL    DIAGNOSTICS. 

in  the  respiratory  apparatus.  IMost  sensitive  in  this  particular 
is  the  superior  laryngeal  nerve,  which  is  the  sensory  nerve  of 
the  larynx,  and  the  first  three  rings  of  the  trachea.  The  mucous 
membrane  of  the  trachea  is  less  sensitive,  except  at  the  bifur- 
cation of  the  bronchi.  The  bronchi  are  just  as  easily  irritated 
as  the  larynx ;  but  cough  can  not  be  excited  from 
the  parenchyma  of  the  lungs.  It  can.  however, 
arise  from  the  pleura  when  this  organ  is  in  a  state  of  irritation. 
Peripheral  irritation  is  transmitted  to  the  cough-center  in  the 
brain,  which  innervates  the  expiratory  muscles  and  recurrent 
nerve,  inducing  the  reflex  spasm  called  cough. 

In  exceptional  cases  cough  can  emanate  from  ter- 
minals of  the  vagus  nerve  lying  outside  of  the  respiratory  appara- 
tus, as,  for  instance,  from  the  external  auditor}-  meatus  [ear], 
nose,  or  abdominal  organs.  According  to  Albrecht  cough  can 
occur  from  abscess  in  the  liver.  These  are,  however,  exceptional 
cases.  Cough  from  the  stomach  has  never  been  ob- 
served in  the  horse.  There  is  a  possibility  that  cough  may  have 
its  origin  in  the  brain.  These  exceptions  are  worthy  of  note  and 
should  be  considered  in  those  cases  of  cough  tlie  cause  of  which 
cannot   be   found   to   lie   in    the   respiratory   apparatus. 

Cough    occurs: 

1.  If  foreign  bodies  are  inhaled:  smoke,  dust  (dusty 
food),  acrid  gases  (ammonia,  sulphurous  acid,  chlorine,  etc.). 

2.  If  cold  air  is  inhaled,  especially  if  the  respiratory- 
tract  is  inflamed:  catarrhs  of  the  trachea  and  bronchi,  pleuritis, 
traumatic  injuries  to  the  pleura  (traumatic  gastro-diaphragm- 
itis  of  the  ox). 

3.  If  miicus,  exudate  or  foreign  bodies  (food)  and  para- 
sites are  present  in  the  air  passages:  Gastrus  larvae  in  the 
larynx,  Syngamus  trachealis  in  the  wind  pipe,  Strongyli  in  the 
bronchi. 

In  no  case  can  cough  originate  when  the  sensory  ter- 
minals of  the  vagus  nerve  are  no  longer 
susceptible  to  irritation.  In  severe  phlegmonous 
diseases  of  the  mucous  membrane,  cough  is  absent.  The  cough 
center  in  the  brain  must  also  be  in  normal  condition.  It  is 
disturbed     when     great    mental    depression 


RESPIRATORY   APPARATUS.  113 

■exists.  Therefore,  when  appreciable  irritations  (rales)  are 
present,  unaccompanied  by  cough,  the  prognosis  is  an  unfavor- 
able one. 

The  character  of  the  cough.  The  character  of  the 
cough  varies  with  the  species  of  animal.  Healthy  horses  have 
a  strong,  vigorous,  loud,  fuU-toncd  cough;  cattle  a  sharper 
defined,  softer,  toneless,  prolonged  cough,  the  glottis  being 
held  open.  The  appearance  of  cough  in  animals  is  always  ab- 
normal; its  character  depends  upon  the  disease  which  causes 
it.  Whether  cough  accompanies  the  disease  or  not  can  usuallv 
be  learned  from  the  anamnesis,  although  we  can  not  depend 
upon  this  to  determine  its  character.  It  is  always  best  that  we 
induce  the  patient  to  cough  in  our  presence ;  this  may  be  done 
by  pincEng  the  upper  three  rings  of  the  trachea  or  pressing 
the  finger  ends  of  both  hands  against  the  arytenoid  cartilages 
of  the  larynx.  In  sensitive  healthy  horses  one  or  a  few  short 
coughs  will  follow  the  manipulation,  while  in  indolent  indi- 
viduals there  is  no  reaction.  In  the  ox  coughing  can  be  in- 
duced in  this  way  only  when  the"  animal  is  diseased. 

If  the  ox  can  be  made  to  cough  by  pinching  the  upper 
trachea  or  larynx,  or  if  coughing  takes  place  in  the  horse 
when  only  slight  pressure  has  been  used,  some  abnormal  irri- 
tation exists.  If  cough  can  be  readily  induced  by  pressing 
the  lower  windpipe,  a  tracheitis  is  present. 

The  frequency  of  the  cough.  A  cough  may 
be  occasional  or  frequent,  continual  or  transitory.  If  the 
cough  is  occasional  usually  only  one  or  a  few  impulses  occur, 
but  when  frequent  several  in  succession —  a  fit  of  coughing. 

The  p  a  i  n  f  u  I  n  e  s  s  of  the  cough  is  recognized'  by  the 
general  behavior  of  the  patient  which  seeks  to  suppress  the 
pain  by  shaking  the  head  and  making  masticatory  and  swal- 
lowing movements.  The  animal  may  also  be  restless,  paw 
and  groan.  A  painful,  painless,  burdensome,  and  torturing 
cough  may  be  distinguished.     The  cough  is  painful  in  acute 


114  CLINICAL    DIAGNOSTICS. 

bronchitis,  pleurisy,  pleurodynia,  and  in  so-called  "whooping- 
cough"  of  dogs ;  painless  in  chronic  laryngitis. 

The  force  of  the  cough  impulse  depends  upon 
the  vigor  of  the  action  of  the  expiratory  muscles  and  the  elas- 
ticity of  the  lungs.  Accordingly,  the  cough  may  be  strong, 
vigorous,  or  zvcak.  It  is  weak  if  expiration  is  difficult  or  if 
the  patient  is  unable  to  cough  vigorously :  reduced,  debilitated 
animals,  pulmonary  emphysema,  bronchitis,  h\-drothorax ;  or 
if  the  expiration  is  painful:  pleurisy,  pneumonia,  pleurodynia. 
The  cough  is  strong  if  the  elasticity  of  the  lungs  is  normal 
and  no  pain  attends  the  act. 

T  h  e  d  u  ration  of  t  li  e  cough  i  m  p  u  1  s  e  is 
determined  by  the  force  with  which  the  pulmonary  air  is  held, 
repressed  by  the  closed  glottis.  If  the  pressure  is  great,  the 
glottis  will  be  suddenly  forced  open  and  the  cough  will  be 
short.  If  the  glottis  is  not  completely  closed  (paralysis  of  the 
arytenoid  cartilage — roaring)  or  the  repression  of  the  air 
causes  pain  (pleurisy),  the  cough  is  long — prolonged. 

The  d  c  p  f  h  an  d  ;;/  a  g  n  i  t  u  d  c  of  the  cough 
depend  partly  upon  the  force  and  duration  of  the  cough  im- 
pulse. The  magnitude  is  influenced  by  the  quantity  of  ex- 
pelled air.     We  speak  of  a  deep  and  a  shalloi^<  cough. 

The  con  g  h  sound  is  dependent  upon  the  force  of 
the  cough  impulse,  the  tension  of  the  vocal  cords  and  the  spe- 
cial condition  of  the  surface  of  the  mucous  membrane.  The 
sound  may  be  loud,  low,  clear,  dull,  sharp,  ivhistling,  dense, 
hollozv,  loose,  moist,  dry. 

The  ''ret  u  r  n  i  in  pulse''  of  the  cough  ( Hus- 
tenruecktstoss).  Each  cough  is  followed  by  a  short,  deep  in- 
spiration. If  the  glottis  is  not  fully  open  at  the  moment  this 
inspiration  takes  place,  the  air  rushing  in  causes  the  partially 
stretched  vocal  cords  to  vibrate,  causing  a  harsh,  short,  laryn- 
geal stenotic  sound  to  be  emitted.  It  is  heard  in  paralysis  of 
the  larynx  (paraplegia,  hemiplegia)  and  in  severe  inflamma- 
tory swelling. 


RESPIRATORY   APPARATUS.  115 

Expectoration.  The  act  of  coughing  tends  to  eject 
-masses  of  mucus,  exudate,  etc.,  from  the  bronchi,  trachea,  and 
larynx.  Animali,  do  not  expectorate  because  that  which 
is  coughed  up  into  the  throat,  as  soon  as  it  reaches  the  phar- 
ynx, is  swallowed.  Sometimes,  however,  a  part  is  discharged 
through  the  mouth,  the  lower  naso-pharyngeal  wall  and  the 
soft  palate  being  forced  forward  by  the  air  passing  out,  which 
leaves  the  opening  into  the  buccal  cavity  free.  The  thus  ex- 
pectorated mass  is  usually  mixed  with  mucus  from  the  phar- 
ynx and  mouth  and  also  with  food  particles. 

It  is  possible  to  collect  "sputum"  from  horses  and  cattle 
for  microscopic  or  bacteriological  purposes.  The  method  of 
obtaining  it  is  to  cause  the  animal  to  cough,  then  place  a  spec- 
ulum in  the  mouth  and  reaching  back  with  your  hand  as  far 
as  the  larynx,  gather  the  accumulated  mucus  in  this  region. 

Several  times  in  horses  suffering  from  tuberculosis  I 
have  thus  succeeded  in  obtaining  bronchial  discharge  in  which 
tubercle  bacilli  were  found. 

VII.     The  Voice. 

Cattle  suffering  from  nymphomania  keep  up  an  almost 
■continuous  bellowing ;  in  advanced  cases  they  moan  loudly 
and  constantly.  At  the  approach  of  death  horses  sometimes 
utter  a  shrill  neigh. 

Change  in  voice  is  of  little  significance  in  animals. 
Commonly  we  observe  a  hoarse  voice  in  laryngeal  catarrhs. 
This  is  most  marked  in  dogs.  In  rabies  the  voice  sufifers 
change.  In  dogs  afifected  with  this  disease  the  bark  is  pro- 
longed into  a  long,  dismal  howl,  the  voice  being  at  the  same 
time  hoarse.     In  horses  a  short,  squealing  tone  is  emitted. 

VIII.     The  Larynx  and  Trachea. 

Inspection.  Enlargements  in  the  region  of  the  larynx 
are  as  a  rule  not  confined  to  this  organ,  but  to  neighboring 
tissues  as  the  pharynx,  lymph  glands,  subcutis. 


116 


CLINICAL    DIAGNOSTICS. 


In  birds  the  larynx  may  be  inspected  by  simply  opening- 
the  bill  and  pressing  the  larynx  upwardly.  In  dogs  and  cats, 
and  to  a  more  limited  extent  in  goats  and  sheep  a  view  of  the 
larynx  may  be  obtained  by  opening  the  mouth  and  drawing  the 
tongue  forward. 

Laryngoscopy. 

With  the  aid  of  the  laryngoscope  invented  by  Polansky 
and  Schindelka,  the  interior  of  the  larynx  may  be  examined 
directly.  For  the  diagnosis  of  inflammatory  conditions  in  the 
larynx  this  examination  is  of  no  practical  value.     However, 


Fig.  31. 
View  of  the  larynx  with  paralysis  of  the  left  side,  as  seen  through  the  laryngoscope. 

in  paralysis  of  the  arytenoid  cartilages  the  instrument  can  be 
used  to  advantage.  [This  instrument,  which  is  a  modified 
endoscope,  consists  of  a  cylinder  56cm  long  and  4.7cm  in  diam- 
eter, at  one  end  of  which  is  an  optical  illuminating  apparatus. 
The  light  is  furnished  by  an  electric  battery,  and  undue  heat 
is  prevented  by  a  special  cooling  arrangement.  The  instrument 
is  inserted  through  the  nostrils  and  can  be  used  in  the  horse 
without  casting.]  In  left-sided  paralysis  of  the  larynx  (roar- 
ing) the  left  arytenoid  cartilage  is  seen  to  project  farther  into 
the  lumen  of  the  organ  than  the  right  one.  This  can  be  more 
distinctlv  seen  when  the  larynx  is  moving.    As  the  larynx  o£ 


RESPIRATORY   APPARATUS.  117 

the  horse  is  usually  held  in  the  position  of  "middle  inspiration  " 
It  IS  necessary  to  induce  forced  inspiration  and  expiration  To 
do  this  the  thorax  is  encircled  with  a  girth  which  is  slowly 
and  gently  drawn  tight  and  relaxed,  alternately,  imitating 
forced  breathing.  The  larynx  in  the  meantime  is  watched 
through  the  mstrument.  At  each  inspiration  the  healthy  car- 
tilage IS  seen  to  move  outwardly,  while  at  each  expiration  it 
approaches  the  middle  line.  The  diseased  cartilage,  on  the 
other  hand,  either  remains  completely  at  rest  (paralysis)  or  its 
movements  are  very  tardily  performed    (paresis). 

In  bilateral  paralysis  (paraplegia)  of  the  larynx  the 
patient  may  show  dyspnea  when  at  rest— at  any  rate,  slight 
excitement  will  induce  it.  In  such  cases  one  will  note  that 
both  arytenoids  protrude  into  the  lumen  of  the  larynx  at  inspi- 
ration ;  at  expiration  they  are  suddenly  forced  laterally  and  set 
in  vibration.  The  paralysis  can  be  complete  or  incomplete; 
It  may  not  be  developed  to  the  same  degree  on  both  sides. 

Palpation.  When  we  determine  the  seat  of  the  en- 
largements by  palpation  we  ma^  at  the  same  time  note 
their  temperature,  sensitiveness,  and  the  ease  with  which 
cough  can  be  induced  by  pressing  upon  them.  Where  much 
exudation  is  found  in  the  larynx,  infiltration  of  the  vocal  cords 
or  other  folds  of  mucous  membrane,  a  trembling  of  the  organ 
may  be  felt  {laryngeal  fremitus). 

In  examining  the  trachea  we  should  look  out  for  scars 
resulting  from  tracheotomy  wounds.  The 
form  of  the  trachea  should  also  be  noted.  In  chronic  trachei- 
tis of  the  ox  the  trachea  may  be  shaped  like  a  saber  scabbard. 
Flattening  of  the  trachea  in  horses  is  probably  due  to  a 
paralysis  of  the  transverse  muscle. 

On  auscultation  of  the  larynx  or  trachea,  nor- 
mally a  stenotic  sound  is  heard  [Hke  a  German  "ch"].  It  is 
due  to  a  vibration  of  the  vocal  cords  and  laryngeal  walls  which 
is  produced  by  the  air  forced  through  the  organ.  It  is  heard 
best  at  expiration.  When  the  mucous  membrane  of  the  lar- 
ynx is  swollen  and  firm,  this  sound  becomes  very  pronounced 


118 


CLINICAL    DIAGNOSTICS. 


and  assumes  a  z^'histliiig  or  hissing  character.  If  the  sweUing 
of  the  laryngeal  mucous  membrane  is  loose,  or  deposits  of  exu- 
date cover  the  membrane,  the  sound  produced  is  rattling  or 
purring. 

IX,     Percussion  of  the  Thorax. 

To  properly  percuss  the  lungs  a  knowledge  of  their  topo- 
graphical position  is  essential. 

Anatomy.  The  lungs  and  heart  do  not  occupy  the  whole  of 
the  thoracic  space.  The  abdominal  viscera  encroach  upon  a 
greater  part  of  it.  The  partition  between  the  chest  and  abdominal 
organs  is  the  diaphragm.  This  organ  is  inserted,  in  the  arc  of  a 
circle,   to   the   inner   surface   of   the    whole   thorax,   reaching   in   an 


Fig.  32. 

Dorsal  and  ventral  boundaries  of  the  field  of  pulmonary  percussion.     —  -  —  Costal 

attachment  of  diaphragm.     H.  heart,    d.  c.  dorsal  colon.     1.  v.  c.  left  ventral  colon. 

oblique  direction  from  the  sternum  backwardly  and  upwardly  to 
the  lumbar  vertebrae.  In  the  region  of  the  sternum  its  points  of 
attachment  are  at  the  union  of  the  ribs  to  their  cartilages,  farther 
posteriorly,  howev*er,  the  diaphragm  does  not  extend  down  as 
far  as  th-^  cartilages  of  the  false  ribs,  but  passes  obliquely  across 
their  inner  surfaces  until,  finally,  at  the  last  rib.  it  finds  attach- 
ment  at    the   superior   end.      The   diaphragm   arches   forward   from 


RESPIRATORY   APPARATUS. 


119 


its  points  of  insertion,  extending  into  the  thoracic  cavity  in  the 
shape  of  a  cone  the  apex  of  which  reaches  in  the  various  ani- 
mals, somewhat  beyond  the  middle  of  the  7th  or  8th  rib.  At 
expiration  the  diaphragm  lies  with  its  muscular  portion  directly 
against  the  lateral  chest  wall,  the  tendinous  portion  then  forming 
the  partition.  With  the  beginning  contraction  of  the  diaphragm 
at  inspiration  the  arch  becomes  flattened  in  that  the  organ  is 
drawn  away  from  the  inner  wall  of  the  chest.  The  space  left 
by  the  receding  diaphragm  is  immediately  occupied  by  the  sharp 
borders  of  the  lungs  which  then  lie  close  to  the  points  of  insertion 
of  the  diaphragm.  At  the  acme  of  inspiration  the  rounded,  cone- 
like form  of  the  diaphragm  becomes  more  pointed  and  its  base 
and  apex  approach  each  other,  the  ribs  having  been  drawn  for- 
ward. By  this  drawing  forward  of  the  ribs  the  transverse  diam- 
eter of  the  thorax  is  increased  and  the  base  of  the  cone-like  dia- 
phragm broadened.      (See  page  92.) 


Fig.  33. 
—  —  Dorsal  and  Ventral  boundaries  of  field  of  pulmonary  percussion.      —  -  — 
attachment  of  diaphragm.     —  -  -  —  Curvature  of  diaphragm  in  median  plar 
Anterior  boundaries  of  stomach  divisions.     H.  Heart.     P.  Paunch. 


Accordingly,  the  lateral  border  of  the  lung  is  continually 
moving  backward  and  forward,  traveling  a  distance  in  the  larger 
animals  of  1-3  hands  breadth,  and  in  the  smaller  ones  from  ^  to  1 
hands  breadth.     On  an  average  the   posterior  border  of  the  lung 


120 


CLINICAL    DIAGNOSTICS. 


may  be  defined  by  a  line  which  in  tlie  larger  animals  is  the  width 
of  a  hand  from  the  points  of  insertion  of  the  diaphragm.  In 
small  animals   the  distance   is  one-half  this. 

The  availableness  of  the  lungs  for  clinical  examination. 
Dorsally  the  area  of  percussion  is  defined  by  the  thick  muscles 
of  the  back.  This  boundary  to  percussion,  which  varies  with 
the  condition  of  the  animal,  is  limited  by  a  line  drawn  from  the 
posterior  angle  of  the  scapula  to  the  external  angle  of  the  ilium. 
Anteriorly  the  boundary  is  formed  by  the  scapula  and  the 
massive  shoulder  muscles. 


Fig.  34. 
Heart,  shaded  portion  not  covered  by  lung.      —  Field  of  pulmonary  percussion. 
—  -  —  Insertion  of  diapragm.    L.  Liver.    M.  Spleen.    N.  Kidneys. 
R.  Rectum.    D.  Small  intestines. 


By  drawing  the  leg  forward  the  field  of  percussion  can  be 
somewhat  enlarged.  Vcntrally  the  density  of  the  sternum  and 
muscles  overlying  it  render  in  this  region  the  lungs  unavail- 
able to  percussion. 

The  field  of  percussion  is  a  right-angled  tri- 
angle the  right  angle  of  which  lies  at  the 
base  of  t  h  e  s  c  a  p  u  1  a  .  In  all  animals  the  dorsal  and 
anterior  boundaries  of  the  field  of  percussion  are  the  same,  the 
only  variation  being  in  the  abdominal  boundary. 


RESPIRATORY   APPARATUS.  121 

Horse.  The  abdominal  boundary  is  a  line  drawn  from 
the  16th  intercostal  space,  crossing  the  middle  of  the  thorax  at 
the  11th  rib,  to  the  olecranon. 

The  vortex  of  the  diaphragm  lies  slightly  above  the 
of  the  thorax  at  the  8th  intercostal  space. 

Ox.  In  ruminants  the  field  of  percussion  is  small  on  ac- 
count of  the  less  number  of  ribs  (13),  which  causes  the  dia- 
phr3p--'i  to  lie  farther  forward. 

The  abdominal  boundary  in  this  animal  is  a  line  drawn 
from  the  11th  intercostal  space,  crossing  the  middle  of  the 
thorax  at  the  9th  rib,  to  the  olecranon. 

Dog.  In  the  dog  the  shoulder  lies  well  forward,  which 
gives  a  larger  field  of  percussion.  The  abdominal  boundary  of 
the  field  extends  to  the  9th  rib  at  the  middle  of  the  chest  wall. 

Swine.  In  swine,  percussion  can  rarely  be  employed, 
as  the  thick  layer  of  subcutaneous  fat  and  the  restlessness  of 
the  animal  greatly  interfere.  The  abdominal  boundary  of  the 
field  of  percussion  extends  from  the  11th  rib  to  the  olecranon. 

The  normal  pulmonary  percussion  sound  is  due  to  the 
vibration  of  the  thoracic  w^all.  the  elastic  pulmonary  tissue  and 
to  the  air  contained  in  the  lungs. 

The  intensity  of  the  sound  depends  upon  the 
volume  of  the  air-containing  lung  tissue  which  is  set  in  vibra- 
tion. It  will  vary  with  the  force  used  in  percussing,  the 
thickness  of  the  chest  wall  and  the  volume  of  the  part  of  the 
lung  vibrating.  Accordingly,  more  force  is  employed  in  per- 
cussing a  thick-walled  chest  than  a  thin-walled  one. 

As  the  normal  percussion  sound  at  the 
boundaries  of  the  field  of  percussion 
merges  gradually  into  a  t  >•  m  p  a  n  i  t  i  c  or  a  dull 
sound,  the  exact  borders  of  the  lungs  can 
not  be  definitely  defined  under  the  ham- 
mer. 


122  CLINICAL    DIAGNOSTICS. 

In  vesicular  pulmonary  emphysema,  interstitial  emphy- 
sema (which  is  rare),  and  pneumothorax  the  field  of  per- 
cussion is  somewhat  enlarged  posteriorly,  the  diaphragm  suf- 
fering permanent  backward  displacement. 

An  abnormally  loud,  full  sound  can  be 
heard  under  normal  conditions  if  the  wall 
of  the  chest  is  very  thin,  under  such  circumstances  the  vibra- 
tion of  the  lung  being  unusually  audible. 

Exaggerated  pulmonary  resonance  oc- 
curs: 

1.  If  the  lung  is  much  inflated  with  air  (emphysema). 

2.  If  the  lung  is  abnormally  distended  with  air  as  it  oc- 
curs at  the  border  of  pleural  exudate. 

3.  In  pneumothorax. 

If  the  dull  or  flat  percussion  sound  is  heard  where 
the  sound  should  be  resonant,  it  always  signifies  disease.  It 
occurs : 

1.  If  the  lung  tissue  becomes  dense 
from 

a.  Pneumonic  hepatization:  in  contagious 
pleuropneumonia  of  the  horse,  and  in  contagious  pleuro- 
pneumonia of  the  ox  as  a  rule  a  large  portion  of  the  lung  be- 
comes solid  and  liver-like,  and  emits,  on  percussion,  a  dull  or 
flat  sound.  In  catarrhal  pneumonias  the  pulmonary  sound  is 
not  so  flat,  because  the  solidification  of  the  lung  is  not  com- 
plete, the  morbid  process  appearing  in  the  form  of  more  or  less 
isolated  centers  or  foci  which  are  not  entirely  void  of  air.  In 
hypostatic,  metastatic,  and  ichorus  pneumonias,  swin  plague, 
dog  distemper,  verminous  pneumonia  and  tuberculosis  the 
percussion  sound  is  not  diffusely  dulled,  but  a  dull  sound  is 
emitted  over  the  dense  diseased  centers  only. 

.  b.     Chronic     interstitial    pneumonia     com- 
bined with  atelectasis. 

2.  If    tumors   or   neoformations   are   pres- 


TtESPIRATORY    APPARATUS.  123 

e  n  t  in  the  IniT^s  :  g-landers,  tuberculosis,  carcinoma,  sarcoma, 
echinococci,  etc. 

3.  If  an  airless,  s  o  1  i  d  m  e  d  i  u  m  c  o  m  e  b  e  - 
t  ween    the    1  u  n  g    and    the    p  1  e  x  i  m  e  t  e  r  . 

Inflammation,  swelling-  of  the  thoracic  wall  (after  mus- 
tard applications)  ;  neoformations  on  the  pleura;  collection  of 
considerable  fluid  exudate  or  transudate  in  pleuritis.  conta- 
gious pleuropneumonia  of  the  horse,  contagious  pleuro- 
pneumonia of  the  ox,  and  in  swine  plague.  In  the  horse  the 
presence  of  but  a  few  litres  of  fluid  in  the  chest  cannot  usually 
be  determined. 

Pleuritic  dullness  is  characterized  by  its  ]iori::onial  upper 
boundary  which  shifts  if  the  position  of  the  body  is  changed, 
the  contained  fluid  seeking  the  lowest  level.  This  latter  is 
most  marked  in  small  animals. 

The  tympanitic  percussion  sound  is  abnormal 
when    it    occurs    in    the    thorax.      It  appears : 

1.  In  collapse  of  the  pulmonary  tissue 
from  a  retraction  of  the  lungs  in  the  presence  of  pleuritic  exu- 
date. The  collapsed  lung  floats  upon  the  exudate,  hence  above 
the 'horizontal  line  of  dullness  a  tympanitic  zone  exists. 

a.  In  the  first  and  last  stages  (resolution)  of  pneumonia. 

b.  If  numerous,  small  tumors  occur  in  the  lungs  and  the 
pulmonary  tissue  amid  them  is  collapsed. 

2.  If  caverns,  or  large  bronchiectases 
[morbid  dilatations  of  the  bronchi]  are  present  in  tl::  L:ngs. 
The  intensity  and  clearness  of  the  tympanitic  tone  depends 
upon  whether  the  cavities  momentarily  contain  air  or  exudate. 

The  tvmpani:;ic  percussion  sound  has  a  metallic  tinkling, 
tone  wl'.en  t!:e  v/r.Ils  o£  the  cir-ccntaining  cavity  are  smooth 
and  distended. 

Tlic  cracked-pot  resonance.  [This  resembles  the  sound 
produced  by  striking  the  hands,  loosely  folded  across  e.vh 
other,  against  the  knee,  tlie  contained  air  being  suddenly  forced 
out  between  the  fingers — Loomis].     It  occurs  in  t'le  thorax 


134  CLINICAL    DIAGN-OSTICS, 

when  a  large  air-containing  cavern  is  in  direct  communication 
with  a  bronchus.  Forcible  percussion  causes  some  of  the  air 
to  be  suddenly  driven  out  of  the  cavern  into  the  communicat- 
ing bronchus,  thus  inducing  this  peculiar  resonance.  The 
cracked-pot  resonance,  however,  does  not 
always  indicate  the  presence  of  a  cavern 
inthelung. 

3.  In    pneumothorax. 

4.  In  prolapsus  of  bowel  into  the  thoracic 
cavity  through  the  ruptured  diaphragm, 

X.     Auscultation  of  the  lungs. 

During  breathing,  when  the  air  enters  the  lung  and  causes 
it  to  move,  sounds  are  produced.  The  occurrence  and  charac- 
ter of  these  sounds  furnish  important  data  in  regard  to  the 
condition  of  the  air  passages  and  of  the  surface  of  the  lung. 
The  intensity  of  the  sounds  varies  with  the  depth  of  the  res- 
pirations ;  when  the  breathing  is  forced  they  are  augmented. 
Therefore,  to  make  them  more  audible  it  is  sometimes  advisa- 
ble to  exercise  the  patient  before  auscultating.  The  sounds 
may  also  be  made  more  distinct  by  holding  the  nostrils  shut 
for  a  few  moments.  The  partial  closing  of  the  nostrils,  how- 
ever, recommended  by  some,  is  not  admissible,  as  it  induces 
a  stenotic  tone  which  might  prove  misleading. 

a.  The  vesicular  murmur.  In  auscultating  the  thorax 
over  healthy  lung,  we  perceive  a  soft,  sipping  sound,  the  vesic- 
ular or  alveolar  murmur.  The  sound  can  be  imitated  by 
softly  pronouncing  the  letter  "v."  It  begins  with  the  inspira- 
tion, increasing  as  the  inspiration  continues,  and  becomes  at 
expiration,  a  fainter,  shorter  sound,  having  the  character  of  a 
softly  aspirated  letter  "f." 

As  a  rule  the  rnurmur  is  softer  and  less  distinct  in  the 
horse  than  in  the  ox. 

As  with  the  laryngeal  respiratory  sound,  so  are  other 
sounds  originating  in  the  upper  air  passages  transmitted  to  the 


RESPIRATORY    APPARATUS.  125- 

lungs.  These  are  rattling  throat  sounds,  wheezing,  groaning, 
etc.  Their  appearance  in  the  chest  has  no  diagnostic  signifi- 
cance. 

An  exaggerated  vesicular  murmur  occurs: 

1.  If  the  respirations  are  intensified,  therefore  in  physio- 
logical and  pathological  dyspnea. 

•?.  If  it  is  compensatory;  that  is,  if  one  portion  of  the 
lung  is  required  to  perform  extra  work  for  another  portion 
which  is  diseased  and  incapable  of  taking  part  in  the  respira- 
tory act,  [For  instance,  where  one  lung  does  the  dutv  of  its 
fellow  which  is  diseased.] 

3.  If  a  bronchitis  is  setting  in,  the  lumen  of  the  bronchi 
being  contracted  by  swelling  of,  or  collections  of  exudate  on, 
the  mucous  membrane.  The  exaggerated  vesicular  murmur 
in  such  cases  is  a  symptom  of  great  diagnostic  importance. 

A  diminished  or  feeble  z'esicular  murmur  occurs: 

1.  If  the  thoracic  wall  is  thickened  from  fat  accumula- 
tions or  disease :  swelling,  neo formations. 

2.  If    the    air    cannot    enter    the    vesicles 
in  consequence  of  great  swelling  or  plugging  of  the  larger  ■ 
bronchi :  severe  bronchitis. 

3.  If  the  exchange  of  gases  in  the  lungs 
is  impaired:  emphysema,  beginning  hepatization,  and  a 
partial  compression  of  the  lungs  by  pleuritic  exudate. 

Absence  of  the  vesicular  murmur,  and  no  other  sounds 
present  in  the  lung  [i.  e.,  total  absence  of  any  pulmonary 
sound]  occurs: 

1.  If  pleural  exudates  or  tumors  have  displaced  the  lung 
tissue : 

2.  Rarely  in  severe  vesicular  pulmonary  emphvsema,  or  a 
complete  occlusion  of  a  bronchus  preventing  access  of  air  into 
a  certain  portion  of  the  lung. 

Jerking,  interrupted  respiratory  sounds  are  often  produced 
by  animals  voluntarily,  from  restlessness  or  fear.  In  such 
cases  it  is  heard  in  both  lungs.     Pathologically     it    is 


126  CLINICAL    DIAGNOSTICS. 

confined  to  certain  portions  of  a  lung, 
and  is  observed  when  the  free  entrance  of  air  into  the  vesicles 
is  made  difficult  by  a  contraction  or  occlusion  of  the  bronchi 
(bronchitis ). 

b.  Bronchial  tones.  The  bronchial  respiratory  sound 
is  normal  in  the  larynx  and  trachea ;  i  t  s  appearance  in 
the  chest  is  always  a  sign  of  disease.  It 
is  audible  only  when  the  bronchi  are  free  and  the  vesicles  con- 
tain no  air. 

Bronchial  respiration  displaces  vesicular  respiration : 

1.  If  .the  vesicles  are  filled  with  exudate,  therefore  in  all 
pneumonias,  especially  in  contagious  pleuropneumonia  of  tlie 
horse  and  in  contagious  pleuropneumonia  of  the  ox.  To  be 
heard,  however,  the  hepatized  portion  of  the  lung  must  be  of 
the  size  of  a  double  clenched  fist  and  lie  next  to  the  costal 
wall. 

2.  If  the  lungs  are  compressed  by  pleuritic  exudate 
(atelectasis).  The  compression  must  be  complete,  for  if  the 
vesicles  contain  air  at  all  a  feeble  vesicular  murmur  can  still 
be  heard. 

A  special  v  a  r  i  c  t  }•  of  bronchial  r  e  s  p  i  r  - 
a  t  i  o  n  is  the  amphoric  respiration,  which  is  a  bruit,  of  a  char- 
acter like  the  sound  produced  by  gentl}-  blowing  across  the 
mouth  of  a  narrow-necked  bottle.  In  animals  it  is  rare,  l;ut 
appears  if  large  caverns  in  the  lung  communicate  with  bronch.i 
(pulmonary  gangrene ) .  ( )  n  percussion,  i  n  p  lace 
of  the  d  ul  1  e  d  s  o  u  n  d  which  is  usual  w  h  e  n 
the  respiration  is  bronchial,  a  t  }•  m  p  a  n  i  t  i  c 
tone     or    a    c  r  a  c  k  e  d  -  p  o  t     resonance    is    heard. 

That  bronchial  respiration  may  become  audible  the  bronclii 
must  not  be  occluded;  if  they  are  filled  with  masses  of  exu- 
date, no  respiratory  sound  is  heard.  A  forcible  cough,  how- 
ever, may  dislodge  and  eject  the  exudate  and  the  i:ronchi  be- 
come free  a-^rain. 

c.  The  vague  cr  indefinite  respiratory  sounds.     Sv;c!i 


RESPIRATORY    APPARATUS.  127' 

sounds  are  spoken  of  when  it  can  not  be  determined  whether 
they  belong  to  the  vesicular  or  bronchial  respiration.  A'ague 
respiration  is  heard  if  hepatization  is  setting  in,  the  vesicular 
murmur  becoming  weak  and  the  bronchial  sound  just  begin- 
ning. A  slight  compression  of  the  lungs  or  partial  occlusion 
of  the  bronchi  with  exudate  may  also  produce  it. 

d.  Rales  or  rhonchi.  Rales  are  heard  in  disease  and 
appear  if  the  bronchi  or  a  cavern  in  the  lung  contain  movable 
exudate  against  which  air  is  forced. 

1.  Moist  rales  appear  if  the  bronchi  contain  a. 
-quantity  of  light,  fluid  exudation  (bronchitis).  The  larger  the 
bronchi  and  the  greater  the  quantity  of  exudate  they  contain, 
the  larger  will  be  the  bubbles  and  the  coarser  the  rales. 
In  the  large  bronchi  and  in  caverns,  the  rales  may  assume  a 
gurgling  or  bubbling  character.  We  also  distinguish  medium,, 
coarse,  and  tine  rales ;  the  latter  originating  in  the  bronchioli. 

Rales  may  occur  irregularly  and  are  not  always  of  like 
intensity.  Sibilant  rales  are  heard  only  at  inspiration,  increas- 
ing in  intensity  as  the  inspiration  progresses;  coughing  may 
temporarily,  remove  them.  The  intensity  of  rales  depends  upon 
the  extent  of  the  disease  and  the  topographical  position  of  the 
diseased  part. 

Moist  rales  originate  from  the  to-and-fro  movement  of 
mucus  [pus,  blood,  liquid  exudate],  the  forming  and  bursting- 
of  bubbles,  and  the  vibrations  produced  by  these  acts.  Accord- 
ing to  whether  rales  attend  vesicular,  bronchial  or  amphoric' 
respiration  their  tone  will  vary ;  metallic  rales  as  a  rule  accom- 
pany bronchial  respiration. 

By  crepitant  rales:  we  understand  very  fine,  crackling 
noises,  which  resemble  the  sound  heard  when  the  ear  is  rested 
very  lightly  upon  the  haired  skin  of  an  animal.  Taking  their 
origin  into  consideration  they  can  be  grouped  with  neither  the 
moist  nor  the  dry  rales.  They  originate  from  a  separation,  at 
inspiration,  of  the  adhering  walls  of  the  bronchi  and  vesicles. 
They  appear  in  Irrcr.chioHt::,,  pulmonary  edema  and  in  the 


128  CLINICAL    DIAGNOSTICS. 

■exudative  (early)  stage,  and  last  stag-e  (resolution)  of  fibrin- 
ous pneumonia  (contagious  pleuropneumonia  of  the  horse). 

2.  Dry  rales  appear  if  a  email  quantity  of  a  tough 
bronchial  secretion  is  present,  or  if-  the  mucous  membrane  is 
greatly  swollen.  These  conditions  produce  stenosis  of  the 
bronchi,  hence  the  sound  is  stenotic  and  of  a  sonorous,  luim- 
Diiiiij;,  hissin!^,  squeaky.  zcJiisili)!^:^,  (sibilant)  character.  Dry 
rales  most  commonly  attend  chronic  diseases :  chronic  bron- 
chitis, compression  of  the  bronchi  by  nodules  (tuberculosis, 
chronic  pneumonia)  and  tumors  (echinoccocci).  In  the 
echinococcus  disease  of  the  ox  the  rale  has  a  peculiar  (quurk- 
send)  character. 

A  wheezing,  crackling,  whistling  or  piping,  rale-lik? 
sound  is  heard  in  interstitial  emphysema  of  the  lungs.  It  is 
most  pronounced  during  expiration. 

e.  Pleuritic  friction  sounds.  Normally  the  pulmon- 
ary pleura  plays  noiselessly  upon  the  costal  pleura  during  th.e 
movements  of^each  respiratory  act.  If,  however,  the  pleurae 
become  rough  and  dry  from  inflammatory  deposits  upon  the:r.. 
a  sound  is  produced  at  respiration.  This  sound  is  best  hear  1 
where  the  movement  of  the  pleural  laminae  is  greatest.  t!ie:e- 
fore  near  the  sharp  borders  of  the  lung.  The  intensity  of  pl'rr.- 
ritic  friction  sounds  depends  upon  the  extent  of  the  di2eas2 
[pleuritis].  They  are  audible  as  o-ra:::iiig  or  ruhbiug  sou::cL 
just  below  the  ear ;  if  there  is  an  intimate  adhesion  the  sound 
is  emitted  in  a  series  of  jcrkiii'^,  ci'cakiiii^,  or  crackling  noises. 

A  pleuritic  friction  sound  appears  in 
dry  or  fibrinous  pleuritis  only.  It  is  most 
frequently  heard  in  contagious  pleuropneumonia  of  the  horse 
and  in  contagious  pleuropneumonia  of  the  c-c.  It  rarely 
occurs  from  the  presence  of  tumors  or  neoformni^n:  upon  the 
pleura.  In  tuberculosis,  as  a  rule,  no  fric- 
tion   sound    is    heard. 

Pleuritic  friction  sounds  are  easily  confused  with  rales. 
Friction    sounds    are  heard  regularly  at  inspiration  and 


RESPIRATORY    APPARATUS.  129 

expiration,  may  sometimes  even  be  felt,  and  occur  most  fre- 
quently in  a  series  of  abrupt,  jerking  noises  upon  which  cough 
has  no  influence.  Rales  are  commonly  more  pronounced 
at  mspiration  than  at  expiration,  are  not  jerking  in  character, 
and  are  removed  or  modified  by  cough. 

Diseases     of    the     Respiratory    Apparatus. 

a.  Cavities     of    the     Head. 

Acute  nasal  catarrh.     Rhinitis  catarrhosa.     Congestion  of  the 

disH™e"'"n'"l"''',''''°'!'  '''  '""'^°"'-  '■''^'■^'>'  mucopurulent  nasal 
discharge.  Only  when  disease  is  severe  is  mild  fever  present: 
transient  swelling  ot  the  submaxillary  lymph  glands. 

Chronic  nasal  catarrh.  Mostly  unilateral.  Discharge  often 
mucopurulent  or  light  colored  and  "glassy"  in  appearance;  quan- 
tity varies  Isasal  mucous  membrane  pale,  sometimes  catarrhal 
erosions.      Enlargement   of   the   submaxillary   lymph  glands. 

Chronic  catarrh  of  the  superior  maxillary  and  frontal  sinuses. 
Symptoms  of  unilateral  chronic  nasal  catarrh.  When  head  is 
lowered  discharge  suddenly  increases.  Bulging  of  the  diseased 
sinuses;  it  tilled  with  exudate  flat  sound  on  percussion. 

Tumors  in  the  cavities  of  the  head.  Most  common  are  sar- 
comas m  the  sinuses  and  polypi  in  the  nasal  cavities.  Chronic 
nasal  discharge,  enlargements,  wheezing  respiratory  sounds,  sub- 
maxillary glands  also  diseased. 

Parasites  in  the  cavities  of  the  head.  Larvae  of  Oestrus  ovis 
in  the  sheep,  pentastomum  taenioides  in  the  dog.  Sneezing,  nasal 
discharge,  wheezing  respirations,  brain  symptoms. 

b.  L  a  r  y  n  x     and     Bronchi. 

Acute   laryngeal   catarrh.     Laryngitis    acuta.      Cough   which   is 

at  hrst  dry  and  painful,  later  more  moist.  When  disease  is  severe- 
mild  fever,  accelerated  pulse,  dyspnea  with  laryngeal  stenotic 
sound. 

Croupous  laryngitis.  Sudden  fever,  sometimes  chills  Per- 
sisteTit,  hacking  cough.  Loud  laryngeal  stehotic  sounds,  great  in- 
spiratory dyspnea. 

Edema  of  the  glottis.  Suddenly  appearing  severe  inspiratory 
dyspnea,  loud  wheezing  or  shrieking  respiratory  noise,  head  held' 
extended.  Stenotic  sound  does  not  disappear  by  partially  closing- 
the  nasal  openings.     Peracute   course. 

_  Chronic  laryngeal  catarrh.  Cough,  especially  when  the  animal- 
is  first  brought  out  into  the  air  and  at  work. 

Roaring.  Hemiplegia  laryngis  sinistra.  An  atrophy  of  the 
muscles  of  the  larynx  due  to  a  paralysis  of  the  inferior  laryngeal 
nerve    (recurrent),   which    :auses   an   inspiratory   sound.      No   fever 


130  CLINICAL    DIAGNOSTICS. 

no  catarrhal  symptoms.  Prolonged  hoarse  cough  with  Peturn 
sound.  Inspiratory  sound  when  respirations  are  forced.  Partial 
closing  of  the   nasal  openings  causes  sound   to  cease. 

Acute  paralysis  of  the  larynx.  Suddenly  appearing  severe 
inspiratory  dyspnea,  which  is  apparent  when  the  animal  is  at  rest 
or  slightly  excited;  loud  whistling  or  shrieking  respiratory  noises, 
anxiety,  r&stlessness.  Partial  closing  of  the  na'sal  openings  dimin- 
ishes the  sound.     General  condition  not  disturbed. 

Acute  bronchial  catarrh.  May  only  he  diagnosed  when  dis- 
ease is  well  developed.  Fever,  accelerated  pulse,  dyspnea,  cough 
which  is  at  first  dry,  later  loose.  Full  sound  on  percussion.  On 
auscultation,  rales  which  depend  as  to  character  upon  the  seat 
and  quantity  of  the  exudate. 

Chronic  bronchial  catarrh.  No  fever.  As  a  rule  a  short,  dull, 
weak  cough.  Dyspnea  not  pronounced  at  rest;  at  work  marked. 
Sometimes   a  fine-foamy,  serous   nasal   discharge. 

Verminous  bronchitis.  Lung-worm  plague.  Develops  slowlj- 
under  symptoms  of  bronchial  catarrh  with  prolific  exudation.  In 
mucus:  parasites,  eggs,  or  embryos  of  Strongylidae.  Later, 
anemia,  cachexia  and  death. 

Strongylus  filaria  in  sheep  and  goat;  strongylus  micrus  in  ox; 
strongylus  paradoxus  in  swine,  and  strongylus  syngamus  in  fowls. 

c.     Lungs. 

Pulmonary  congestion  and  pulmonary  edema.  Sudden  ap- 
pearance. Scvtre  mixed  dyspnea  up  to  100  respirations  per  min- 
ute. Percussion  normal,  auscultation:  exaggerated  vesicular  res- 
pirations,   crepitant    rales,    rhonchi. 

Pleurodynia.  This  is  a  congestion  of  the  lungs  combined  with 
severe  pains  in  the  thoracic  walls.  General  apathy,  excessive  dila- 
tation of  the  thorax,  which  is  "held."  Groaning.  Respirations  80 
per  minute,  superficial.  Temperature  high-normal,  pulse  accel- 
erated. Super-resonant  sound  on  percussion,  feeble  vesicular 
murmur. 

Catarrhal  pneumonia.  Bronchopneumonia.  Begins  usually  as 
catarrhal  bronchitis.  High,  intermittent  fever,  painful  cpugh. 
Only  when  disease  is  extended  can  pneumonia  be  appreciated; 
circumscribed  patches  of  dullness  on  percussion;  vesicular  mur- 
mur feeble,  rarely   bronchial   respirations. 

Gangrene  of  the  lungs.  Fever.  Breath  at  first  of  a  sickening, 
sweetish  odor,  later  stinking.  Discolored  greyish-brown,  tena- 
cious nasal  discharge.  Percussion:  tympanitic  sound,  cracked-pot 
sound;  at  periphery  of  necrotic  centers,  dullness.  Auscultation: 
large  rales,  bronchial  respiration,  amphoric  sound.  Not  infre- 
quently  combined,  with   pleuritis. 

Alveolar  emphysema.  May  only  be  diagnosed  when  well  de- 
veloped. Expiratory  dyspnea  with  "double-pumping"  of  the 
flanks,  protrusion  of  the  anus.     Cough:  short,  dull,  weak.     Super- 


RESPIRATORY    APPARATUS.  131 

resonant  percussion-sound,  held  of  percussion  enlarged  posteriorly. 
Auscultation  shows  the  vesicular  murmur  to  be  diminished. 

Interstitial  pulmonary  emphysema.  Suddenly  appearing  mixed 
dyspnea.  Cough  very  superhcial  or  absent.  Super-resonant  per- 
cussion sound  with  tympanitic  accessory  sound  extended  poster- 
iorly. A  piping  sound  in  auscultation.  Emphysema  of  the  skin 
frequent. 

Echinococcus  disease.  Ox.  Diagnosis  is  only  possible  when 
large  numbers  of  the  echinococcus  bladders  are  in  the  lungs.  No 
fever.  Dyspnea.  Cough  weak  and  blowing.  Percussion  dulled 
in  patches  or  tympanitic.     Vesicular  respirations  diminished. 

d.     Pleura. 

Pleurisy.  Pleuritis.  Fever  depending  upon  the  character  of 
the  inflammation.  Respirations  accelerated  and  dyspneic.  Fre- 
quent, painful,  weak  cough.  Horizontal  line  of  dullness  on.  per- 
cussion above  which  a  tympanitic  sound  is  observed.  Percussion 
will  vary  with  the  position  of  the  body  of  the  patient.  In  early 
stages  friction  sounds  are  heard  on  auscultation,  later  when  much 
effusion  of  exudate  takes  place  no  respiratory  sounds  are  audible. 

Pneumothorax.  Attends  interstitial  emphj-sema  of  the  lungs 
or  penetrating  wounds  in  the  chest  wall.  Tympanitic  percussion 
sound  in  the  upper  portions  of  the  thorax.     Severe  dyspnea. 

e.     Infectious     Diseases     Which   Involve   the 
Respiratory    Apparatus. 

Contagious  pleuropneumonia  of  the  horse.  (Brustseuche). 
This  is  a  contagious  pneumonia  affecting  the  parenchyma  of  the 
various  organs  and  is  usually  attended  with  secondary  pleuritis. 
1.  Stadium  incrementi  begins  with  high  fever,  yellow  discolora- 
tion of  the  visible  mucous  membranes,  general  weakness,  crack- 
ling of  joints.  2.  Acme.  Does  not  appear  before  the  second  or 
third  day.  Symptoms  of  tibrinous  pneumonia  with  or  w'ithout 
pleurisy,  usually  unilateral.  Rusty  brown  nasal  discharge,  empty 
percussion  sound  with  resistance  under  the  hammer,  bronchial 
respirations.  Pleuritis:  Empty  percussion  sound  limited  by  a 
horizontal  line  above  which  is  a  tympanitic  zone.  Friction  sounds 
which  soon  pass  away,  later  no  sound  or  bronchial  respiration.  3. 
Stadium  decrementi.  The  crisis  appears  in  7  or  8  days,  tempera- 
ture within  24-36  hours  down  to  normal,  all  other  symptoms,  also 
pulse  frequency  gradually  disappearing  in  8  days.  Complications: 
pleurisy,  acute  myocarditis.  Resulting  diseases:  pulmonary  gan- 
grene, abscesses  in  the  lungs,  chronic  pneumonia. 

Scalma  (Dieckerhoff)  is  a  diffuse,  infectious  bronchitis  with 
subacute   course. 

Tuberculosis.  Tuberculosis  is  a  contagious  disease  caused  by 
the  bacillus  tuberculosis  and  characterized  by  the  formation  of 
very  small  inflammatory  centers  w'hich  soon  undergo  degenera- 
tion.     The    disease    develops    very    slowly.      Only    advanced    cases 


132  CLINICAL    DIAGNOSTICS. 

can  be  diagnosed   by  physical  examination.     Symptoms   will  vary 
with  organ   affected.     Very  often  general   emaciation. 

1.  Pulmonary  Tuberculosis.  Respirations  often  unchanged. 
Sometimes  mucopurulent  nasal  discharge,  especially  after  cough- 
ing. Cough  regularly  present.  It  is  at  first  vigorous,  but  later 
becomes  weak  and  not  infrequently  in  paroxysms.  Coughing  may 
be  induced  by  trotting  the  patient  or  by  temporarily  closing  the 
nostrils,  if  it  does  not  occur  spontaneously.  Percussion  rarely 
reveals  much.  Auscultation  more  valuable,  especially  after  exer- 
cise: vesicular  murmur  exaggerated,  rough;  rales  and  vague 
sounds.  Great  tubercular  enlargement  of  the  mediastinal  lymph 
glands  induces  chronic  bloating. 

2.  Udder  Tuberculosis.  Begins  in  one  or  more  quarters  in 
the  form  of  circumscribed,  firm  inflammatory  centers  which  con- 
tinue growing  larger.  After  milking  more  noticeable.  The  supra- 
mammary  lymph  glands  are  enlarged  and  often  nodular. 

3.  Uterine  and  Vaginal  Tuberculosis.  Frequent  periods  of 
heat;  animal  does  not  conceive;  vulva  asymmetrical  or  sunken.  Fre- 
quently mucopurulent  nasal  discharge.  On  mucous  membrane 
small  nodules  and  ulcers  size  of  a  pin  head.  Orificium  uteri  rarely 
closed.  Uterus  enlarged  diffusely  or  in  form  of  nodes.  Fallopian 
tubes  may  be  felt  as  tortuous,  firm  strands  with  nodules  along 
their    course. 

4.  Brain  Tuberculosis.  Disturbance  in  movements  and  hold- 
ing of  head.  Twitchings  and  spasms.  Often  lie  on  one  side, 
unable  to  arise.     Symptoins  may  occasionally  be  acute. 

Strangles.  Coryza  contagiosa  is  an  infectious  catarrh  of  the 
mucous  membranes  of  the  upper  respiratory  passages  with  sec- 
ondary, purulent  inflammation  of  their  corresponding  lymph 
glands.  Begins  with  fever  of  intermittent  character.  Pulse  at 
first  little  increased  but  may  reach  80.  Nasal  discharge  serous, 
mucous  or  purulent,  usually  bilateral  and  profuse.  In  3  or  4 
days  at  latest  inflammatory  swelling  of  the  submaxillary  lymph 
glands,  which  in  4  to  8  days  later  have  abscesses  formed  in  them. 
Pharyngitis  frequently  concomitant.  Dysphagia,  abscess  forma- 
tion in  the  subparotid  and  retropharyngeal  lymph  glands.  If 
larynx  is  involved:  cough,  loud  inspiratory  noises.  In  old  horses 
disease  often  limited  to  the  pharynx. 

Glanders,  malleus,  is  a  contagious  disease  of  solidungula, 
caused  by  the  Bacillus  mallei,  characterized  by  the  formation  of 
nodules  and  abscesses  in  the  respiratory  mucous  membrane  and 
skin.  On  the  nasal  mucous  membrane  we  find  gray  nodules  as 
large  as  millet  seeds,  transparent  and  surrounded  by  a  red  zone. 
The  nodules  become  yellow,  degenerate,  form  ulcers  with  raised 
and  jagged  borders  and  lardaceous  bottom.  Nasal  discharge  slight,, 
frequently  unilateral,  varyingly  sticky,  slimy,  purulent,  occasionally 
discolored  and  bloody.  Intermaxillary  lymphatic  glands  en- 
larged, knotty,  firm,  adhering  to  bone  or  skin.  In  skin  and  sub- 
cutis  rather  flat,  painful,  hot  nodules  varying  in  size  up  to  that 
of  a  hen's  egg,  these  break,  discharge  discolored  pus  and  become 


DIGESTIVE    APPARATUS.  133 

ulcerous.  Lymphatics  efferent  and  afferent  to  these  nodules  are 
enlarged  to  thickness  of  a  finger.  See  also  specific  examination 
for  glanders. 

Contagious  pleuropneumonia  of  cattle  is  a  contagious  crou- 
pous interstitial  pneumonia.  We  distinguish  an  occult  stage 
which  is  marked  by  a  slight  cough,  fever,  and  slight  dyspnea.  In 
the  acute  stage  we  have  distinct  fever — 41°C  [105. 8°F]  and  the 
symptoms  of  an  acute  pleuropneumonia.  Great  dyspnea,  weak, 
short  cough,  some  nasal  discharge,  extended  empty  sound  on  per- 
cussion, friction  bruits,  bronchial  respiration,  rales.  Appetite, 
rumination   and   secretion   of  milk   suspended. 

Malignant  catarrhal  fever  is  a  specific  disease  of  the  ox,  has 
a  subacute  course  and  aftects  chiefly  the  respiratory  and  digestive 
mucous  membranes,  and  the  brain.  Disease  is  introduced  with 
chills.  Great  mental  depression,  muscular  trembling,  stiffness, 
sometimes  inability  to  stand.  Conjunctivitis  and  keratitis.  Diph- 
theritic inflammation  of  the  mucous  membrane  of  the  nose, 
sinuses  of  the  head,  trachea  and  mouth,  rattling,  wheezing  and 
breathing.     No  appetite,  secretion  of  milk  suspended. 

Distemper  of  dogs  is  a  very  contagious  disease  that  is  char- 
acterized chiefly  by  catarrhal  affections  of  the  mucous  membranes. 
Symptoms  quite  varied;  we  distinguish:  catarrhal,  nervous  and 
exanthematous  distemper.  Symptoms  of  the  disease  develop 
slowly.  Animals  are  indisposed,  conjunctivitis,  keratitis,  vomiting, 
disturbed  appetite,  slimy  nasal  discharge,  cough,  dyspnea,  tym- 
panitic and  occasionally  dulled  sound  on  percussion  of  lungs,  rales. 
Spasms  affecting  the  whole  body  or  only  certain  groups  of  mus- 
cles, general  muscular  weakness,  paralysis.  Vesicular  and  pustular 
exanthema. 

8.     Digestive  Apparatus. 

Diseases  of  the  digestive  apparatus  are  common  in  domes- 
tic animals.     Their  diagnosis  is.  in  some  respects,  far  more 
difficult  than   that  of  the   respiratory   apparatus  because   the 
organs  concerned  are  not  as  accessible  to  examination.     For 
this  reason  every  possible  factor  must  receive  most  careful 
consideration.     We  observe  these  in  the  following  order: 
I.     Food   and   Drink. 
II.     The    Buccal    Cavity. 
III.     The    Pharynx   and    Esophagus. 
IV.     Rumination. 
V.     V  o  m  i  t  i  n,g  . 
VI.     T  h  e  A  b  d  o  m  e  n  . 
VII.     The    Intestinal    Evacuations. 


134  CLINICAL    DL\GNOSTICS. 

I.     Food  and  Drink. 

Before  examining  the  various  organs  of  the  digestive 
apparatus,  we  must  note  the  animal's  appetite  for  food  and 
drink  as  well  as  the  character  of  these  latter,  also  observe  the 
way  in  which  the  animal  takes  its  food,  masticates  and 
swallows  it. 

a.  Appetite  for  Food.  The  appetite  that  an  animal  manifests 
for  certain  food  depends  in  part  on  its  palatability  and  in  part  on 
the  degree  to  which  the  animal  has  become  accustomed  to  it. 
This  must  always  be  borne  in  mind  when  probing  for 
the  cause  of  poor  appetite,  and  hence  an  inspection  of  the 
food  must  not  be  neglected.  Individual  appetites  vary  widely. 
One  horse  may  be  a  good  feeder,  another  a  poor  feeder,  both 
may  enjoy  perfect  health.  High  strung  horses  often  refuse  their 
food  after  active  exercise,  but  their  appetite  returns  after  a  short 
rest.  A  change  of  stable  or  unaccustomed  loneliness  has  a  marked 
effect  on  the  appetite  of~  some  sensitive  horses.  Of  the  various 
grains  horses  prefer  oats  and  indian  corn  and  of  the  grasses 
sweet  timothy  or  meadow  hay.  Oats  is  by  far  the  most  suitable 
grain  to  feed,  a  horse. 

In  all  serious  cases  of  disease  the  appetite  is  more  or 
less  affected,  hay  or  straw  are  usually  the  last  part  of  the 
ration  refused.  Defective  appetite  alone  is 
neveranindicationofany  particular  dis- 
ease. As  a  rule,  complete  loss  of  appetite  is  an  unfavor- 
able symptom;  on  the  other  hand,  a  good  appetite  in  the 
course  of  a  severe  disease  may  be  regarded  as  a  favorable 
symptom. 

Desire  for  water  depends  in  the  first  place  on 
the  amount  of  water  contained  in  the  feed;  dry  feed  requir- 
ing more  water  than  green  feed;  of  course  some  water  is 
required  in  both  cases.  The  demand  is  also  affected  by  the 
amount  of  water  given  off  through  the  skin,  kidneys  and 
intestines.  Many  horses  are'  very  sensitive  in  the  matter  of 
im.pure  water,  some  even  refuse  "pure"  water  if  of  a  differ- 
ent kind  than  that  to  which  they  have  been  accustomed 
[e.   g.   spring  water  and   rain   water]. 

The  desire  for  zcatcr  is  diiiiinislied  in  colic  and  in  all 
serious   gastric   and   intestinal   affection*?,   {providing  no   diar- 


DIGESTIVE   APPARATUS.  135 

rhea  exists;  horses  with  acute  cerebritis  also  refuse  water. 
Continued  refusal  of  water  is  on  the  whole  considered  as  an 
unfavoraTjle  sign;  when  horses  with  colic  drink  water  it  is 
regarded  as  a  favorable  sign. 

Thirst  is  increased  in  the  course  of  various  diseases: 

1.  Animals  with  fever  like  small  sips  of  fresh  water 
at   frequent   intervals. 

2.  When  the  crisis  occurs  in  influenza  or  contagious 
pleuro-pneumonia  of  the  horse,  increased  renal 
secretion  and  thirst  go  hand  in  hand. 

3.  Exudative   pleuritis    and   peritonitis. 

4.  Diabetes  insipidus  of  horses  is  attended  with 
marked  increase  of  thirst;  several  pailfuls  are 
taken  at  a  time. 

5.  Gastric  and  intestinal  catarrh  [diarrhea]  of  dogs 
— attended   with    frequent   vomiting. 

By  the  term  perverted  or  depraved  appetite  we  mean  the 
craving  of  unnatural  food  by  otherwise  healthy  [  ?]  animals. 
As  a  rule  this  is  a  very  important  symptom.  Of  course  this 
condition  must  not  be  confounded  with  playfulness  of  young 
animals  which  gnaw  at,  bite  and  even  swallow  almost  any- 
thing of  convenient  consistency  and  size.  Thus  cattle  will 
liclc  at  one's  clothes,  dogs  eat  blades  of  grass. 

A  craving  for  alkalies  is  pathological :  e.  g.  straw  soiled 
with  urine  and  feces,  whitewash,  etc.,  on  walls,  wood;  acids 
in  dyspepsia. 

Szi'allozving  indigestible  substances,  like  cloth,  leather, 
wood,  stones,  and  similar  objects  is  observed  in  lick  disease 
of  cattle,  and  wool  eating  of  sheep ;  in  rabies  the  same  is 
observed. 

b.  Manner  of  taking  food.  Healthy  horses  grasp  the 
food  with  their  lips  and  pass  it  into  the  mouth,  then  with  the 
aid  of  the  tongue  and  cheeks  it  is  forced  between  the  molars. 
Sheep  and  goats  do  likewise.  Healthy  cattle  grasp  their  food 
with  the  extended  tongue,  curved  like  a  hook. 


136  CLINICAL    DIAGNOSTICS. 

In  horses  the  following  changes  are  observed : 

1.  In  inflammatory  swelling  of  lips  and  cheeky  as  well 
as  in  paralysis  of  the  cheeks  (facial  or  Tth  nerve),  horses 
take  up  their  food  with  their  teeth  and  experience  difficulty 
in  getting  it  into  the  mouth. 

?..  In  cerebral  depression  they  shOw  similar  peculiari- 
ties ;  while  drinking  they  may  insert  the  nostrils  below  the 
level  of  the  water  and  "masticate"  it. 

3.  In  tetanus  feeding  is  very  laborious ;  mastication  and 
suction  movements  are  impossible  because  the  spasmodic  con- 
traction of  the  masseter  muscles  has  closed  the  buccal  cavity. 

In  cattle  normal  feeding  is  disturbed  in  inflammatory 
affections  of  the  tongue  (actinomycosis),  this  organ  often 
bci  oming  hard  and  rigid  (woody  tongue).  Cattle  thus 
aFccted  grab  their  food  like  dog's. 

The  manner  of  drinking  water  must  also  be 
observed.  Normally  only  dogs  and  cats  lap  their  drink. 
When  the  facial  nerve  is  paralyzed  animals  must  insert  the 
whole  mouth  into  the  w^ater  so  that  they  can  get  it  near 
enough  to  the  pharynx  to  swallow  it. 

c.  Mastication.  The  briskness  with  which  this  act  is 
performed  bears  a  direct  relation  to  the  palatability  of  the 
food  and  the  appetite  of  the  animals ;  healthy  horses  and  cat- 
tle make  60-100  masticatory  movements  per  minute. 

Masticatory,  movements  are  conspicuously  retarded  in 
cerebral  depression,  in  the  course  of  severe  fevers,  and  in 
acute  and  chronic  hydrocephalus.  The  animals  cease  masti- 
cating for  some  time,  seem  "absent  minded,"  and  forget  to 
eat.  This  often  happens  while  the  mouth  is  full  of  feed,  and 
piec'es  of  hay  and  straw  sticking  out  of  it. 

Mastication  is  made  difficult  in  paralysis  of  the  facial 
nerve ;  here  the  food  collects  in  large  masses  in  the  lower 
part  of  the  mouth ;  it  is  also  observed  in  tetanus  or  spasms 
of  the  masticatory  muscles'  due  to  other  causes. 

Mastication  is  impaired  and  laborious  when  mechanical 


DIGESTIVE    APPARATUS.  137 

■defects  of  the  teeth  exist.  Shear  jaws,  and  irregular  teeth, 
projecting  teeth,  etc.  The  animals  masticate  one-sided,  cau- 
tiously and  "easy ;"  they  don't  masticate  thoroughly,  the  food 
is  "crushed  and  bruised"  but  not  "ground." 

Mastication  is  painful  when  acute  inflammatory  condi- 
tions exist  in  the  cheeks,  temporo-maxillary  articulation  and 
in  the  intermaxillary  space  as  they  occur  in  the  course  of 
■distemper  of  horses.  Mastication  may  be  voluntarily  inter- 
rupted. If  sharp  or  pointed  objects  like  nails,  needles,  splin- 
ters of  wood,  etc.,  are  taken  up  with  the  food  horses  open 
their  mouths  wide  and  allow  the  contents  to  drop  out,  aiding 
with  the  tongue.  They  do  the  same  thing  when  injuries 
are  produced  by  sharp  teeth  or  displaced  teeth  (alveolar 
periostitis)  ;  sudden  pain,  produced  by  biting  on  a  diseased 
or  loose  tooth,  produces  the  same  effect.  Horses  with  dis- 
eased teeth  frequently  drop  small  masses  or  balls  of  food 
into  the  manger,  "quibbing."  Some  horses  suddenly  raise 
their  head  while  masticating  and  hold  it  sideways,  open  the 
mouth  and  continue  masticating  in  a  cautious  manner,  at  the 
same  time  making  slow  lateral .  movements  with  the  lower 
jaw.  Varied  as  the  symptoms  that  occur  in  the  course  of 
different  affections  of  the  teeth  may  be,  they  all  have 
o  n  e  t  h  i  n  g  i  n  c  o  m  m  o  n  .  t  h  e  }•  make  mastica- 
tion difficult  and  painful. 

In  dangerous  diseases  we  often  observe  gnashing  of  the 
teeth,  at  the  same  time  this  is  not  a  "prognostically  unfavor- 
able" sign. 

d.  Deglutition.  Deglutition  is  the  closing  act  of 
feeding.  It  is  described  as  occurring  as  follows:  The  lips 
are  closed  and  the  jaws  are  set  together,  then  the  tip,  the 
back  and  the  base  of  the  tongue  are  successively  pressed 
against  the  palate  and  thus  the  contents  of  the  buccal  cavity 
are  forced  into  the  pharynx.  By  contraction  of  the  muscles 
of  the  pharynx  in  front  of  the  food  mass  the  peristaltic  mo- 
tion .thus  inaugurated  carries  the  bolus  into  the  esophagus. 


138  CLINICAL    DIAGNOSTICS. 

At  the  same  time  the  pharynx  is  slightly  raised  and  the  pres- 
sure exerted  on  the  epiglottis  by  the  base  of  the  tongue, 
which  projects  backward/closes  the  larynx  and  allows  the 
food  to  glide  over  it.  The  nasal  openings  leading  into  the 
pharynx  are  closed  during  this  act  by  a  raising  of  the  soft 
palate  and  a  coming  together  of  the  borders  of  the  posterior 
pillars  of  the  fauces-  brought  about  by  contraction  of  the 
muscles  of  the  pharynx. 

A  disturbance  of  normal  deglutition 
is  most  frequently  caused  by  inflammatory  processes  in  the 
pharynx  that  cause  infiltration  and  disturb  the  function  of 
the  local  muscles.  The  result  is  not  only  a  painful  condition 
during  swallowing  but  the  closure  of  the  larynx  or  nasal 
cavities  may  be  incomplete.  Accordingly  we  may  observe 
manifestations  of  pain,  extended  head  and  neck, 
the  animals  often  shaking  their  heads.  Incomplete  closure 
of  the  pharyngeal  openings  results  in  food  particles  entering 
the  larynx  or  nasal  cavities  and  giving  rise  to  cough,  or 
ejections  of  water,  saliva  or  food  through  the  nostrils  (re- 
gurgitation), as  the  case  may  be.  The  degree  to  which  the 
closure  of  the  pharyngeal  openings  is  imperfect,  bears  a 
direct  relation  to  the  severity  of  the  affection.  In  mild  cases, 
fluid  only  is  regurgitated,  noticeable  while  drinking  water. 
Later  on  as  the  case  becomes  aggravated,  solids  also  pass 
out.  When  the  affection  is  mild  and  restricted  to  one  side 
the  regurgitation  may  also  be  unilateral.  Soft  feed  is  more  apt 
to  cause  regurgitation  than  are  solid  substances.  An  inflam- 
matory affection  of  the  pharynx  that  causes  difTficulties  in  deg- 
lutition may  be  primary  (pharyngitis),  or  secondary  to  other 
diseases :  distemper,  morbus  maculosus,  anthrax. 

In  addition,  difficult  deglutition  is  o~bserved  in : 

1.  Paralysis  of  the  pharynx  in  mycoses,  parturient 
paresis,  and  rabies. 

2.  Spasm  of  the  pharyngeal  muscles  in  tetanus. 

3.  Tumors  of  the  pharynx ;  actinomycoma,   lymphoma. 


DIGESTIVE    APPARATUS. 


139- 


Besides  the  symptoms  of  difficult  deglutition  we  observe 
in  addition:  salivation,  foaming  at  mouth,  ejecting  food  from 
mouth  while  coughing,  retention  and  fermentation  of  food 
in  mouth  cavity. 


Inspection  of  thelMouth  Cavity. 


II.    The  Buccal  Cavity. 


We  usually  examine  the  buccal  cavity  by  daylight  and 
without  the  aid  of  instruments ;  artificial  illumination  with 
reflectors,  lamps,  or  electric  lights  is  sometimes  useful  but 
not  necessary. 

Method  of  Examination.  In  the  horse  and  ox  the  hand  is 
passed  into  the  mouth  at  the  bars,  the  tongue  iirmly  grasped,  and 
the  thumb  pressed  against  the  palate.  This  procedure  will,  as  a 
rule,  cause  the  animal  to  open  its  mouth  wide.  Another  prac- 
tical method  consists  in  grasping  with  the  hands,  on  both  sides, 
the  upper  lips  at  the  commissures  and  resting  the  thumbs  against 
the  palate.  In  dogs  and  cats  we  grasp,  with  our  hands,  the  upper 
and  lower  jaws,  at  the  same  time  pressing  the  lips  between  the 
teeth;  hereupon  the  animal  opens  its  mouth  wide  enough  to 
permit    inspection. 

Restless  animals  must  first  be  secured  and  then  towels  or 
cords  are  passed  between  the  dental  arches,  and  by  means  of  these 
the    jaws    are    forced    apart. 


140  CLINICAL    DIAGNOSTICS. 

In  examining  the  mouth  the  following  should  be  ob- 
served : 

The  temperature  is  elevated  in  fever  and  in  local  in- 
flammations of  the  mucous  membrane,  stomatitis  and  in 
pharyngitis. 

Secretion  of  Saliva.  Secretion  is  diminished 
in  all  acute  febrile  diseases,  severe  intestinal  affections,  and. 
as  a  rule,  in  colic. 

An  abnormal  quantity  of  saliva  in  the  mouth 
results  either  from  the  fact  that  the  animal  does  not  swallow 
the  normal  secretion  (dysphagia)  or  that  an  abnormal  secre- 
tion has  occurred,  as  in  simple  catarrhal  or  traumatic  stoma- 
titis, diseased  teeth,  foot  and  mouth  disease,  stomatitis  pustu- 
losa  contagiosa,  malignant  catarrh,  mycoses,  etc.  The  saliva 
passes  off  in  the  form  of  clear  strand's  or  in  the  form  of 
foam  produced  by  masticatory  movements.  In  epilepsy  this 
foam  is  observed  at  the  commissures  of  the  mouth. 

Odor  from  the  mouth.  An  "insipid  sz^'cctish"  odor  is 
observed  when  decomposing  food-particles,  epithelial  cells  or 
saliva  in  the  course  of  stomatitis  catarrhalis,  are  present.  A 
putrid  odor  is  produced  by  decomposition  of  nftrogenous 
substances.  Exudates  are  present  in  malignant  catarrh  and 
stomacace  in  dogs.  A  carious  odor  is  produced  by  suppura- 
tive processes  in  bones,  especially  in  alveolar  periostitis. 

Specific  morbid  conditions.  Clanvnincss  of  the  buccal 
mucous  membrane  occurs  in  digestive  disorders  (loss  of  appe- 
tite) ;  reddening  and  szvelling  of  the  mucous  membrane  with 
loss  of  substance  is  observed  after  the  action  of  irritants  and 
caustics  [chloral  hydrate  pills].  Simple  catarrh  is  attended 
with  similar  but  milder  symptoms. 

Punctifonn  henwrrhages  occur  in  morbus  maculosus 
and  leucemia.  Nodules,  pustules  and  ulcers  in  stomatitis 
pustulosa  contagiosa.  Ulcers  on  the  gums  in  stomatitis 
ulcerosa,  calf  diphtheria,  swine  plague,  mercury  and  lead 
poisoning.     Blisters  in  foot  and  mouth  disease,  small  isolated 


DIGESTIVE   APPARATUS.  '  141 

yellowish  vesicles  in  stomatitis  vesicularis.  Wounds  at  the 
tongue  tip  and  frenulum  are  produced  by  rough  handling 
of  the  bridle  bit;  sharp  teeth  produce  wounds  on  the  inside 
of  the  cheeks,  and  sides  of  the  tongue. 

Foreign  bodies  are  of  frequent  occurrence  in  horses 
[corn  cobs],  dogs,  and  cats,  rare  in  other  animals;  they  con- 
sist of  pieces  of  bone,  needles,  etc.,  occasionally  ring-like 
objects  slip  over  the  tongue  accidentally:  e.  g.  cross  sections 
of  the  aorta,  intestines,  trachea,  iron  rings,  etc.,  [rubber  bands 
slipped  on  intentionally  by  children  during  play].  The  symp- 
toms are:  open  mouth  and  salivation,  attempts  at  removal 
on  part  of  the  animal,  eating  and  drinking  interfered  with, 
the  tongue  swollen. 

Careful  manualaswellasocular  exa  m- 
ination  is  often  necessary  to  recognize 
these   conditions. 

Condition  of  the  teeth.  Examination  of  the  teeth  of 
horses  is  of  particular  importance  on  account  of  the  frequent 
occurrence  of  diseases  and  malformations  of  these  organs. 
In  dogs  diseased  teeth  are  also  common. 

Abnormal  position  of  the  incisors  (par- 
rot mouth  and  pike  mouth)  point  to  the  existence  of  a  similar 
defect  in  the  molars.  Parrot  mouth  is  not  an  uncommon 
occurrence  in  high  bred  colts.  In  ruminants  the  incisors  are 
normally  loose.  Carious  incisors  and  molars  occur  in  dogs 
in  the  course  of  rachitis,  distemper,  anjemia  and  stomacace. 

Careful  examination  of  the  molars 
with  the  aid  of  a  speculum*  is  indicated  when 
horses  reject  food  after  partial  mastication,  when  they  show 
any  abnormal  masticatory  movements,  and  when  large  quan- 
tities of  coarse  food  particles  occur  in  the  droppings.     The 

^fT,^!'-^^'"  *'°'"T  ^  ^Pepulum  is  not  in  all  cases  necessary  for  the  detection  of  defects  or 
ft  tt/i^  T''  '^"""'t'O"^^  the  teeth.  By  passing  the  hand  into  the  mouth  at  the  bars, 
tL  J^  1  V''?^P"®*lu^^^-^.*°"'%"*'J°*^^°PP°s'teside  that  orgran  is  forced  between 
^^LSt  ^Z/^'^*''  °."  that  side  and  the  animal  will  voluntarily  keep  its  jaws  sufficiently 
sXvoftl°.^.^''i"'l^''^'"^r*'-V/  *n^  condition  of  the  teeth  without  endangering  the 
fe/tTanl'&^eTat^  fadn^tf  eStlT'"^  '^''""^'  "^'^  *^  '''''''  '""^  ''''  ""'^  *^ 


142  CLINICAL    DIAGNOSTICS. 

friction  surface  and  the  lateral  faces  of  the  teeth  can  be 
examined  simultaneously  by  letting  the  index  and  middle 
fingers  glide  over  the  former,  the  thumb  and  the  remaining 
fingers  over  the  latter.  Abnormal  conditions  of  the  teeth 
can  usually  be  felt  far  better  than  they  can  be  seen.  We 
should  observe  the  presence  or  absence  of  sharp  points,  slant- 
ing friction  surfaces,  shear  jaws,  interrupted  jazvs,  project- 
ing teeth,  short  teeth,  carious  and  broken  teeth,  cavities,  etc. 

III.     Throat  and  Esophagus. 

Examination  of  the  throat  and  esophagus  is  restricted 
to   external    inspection   and  palpation. 

Inspection.  Diffuse  swellings  in  the  region 
of  the  pharynx  occur  in  phlegmonous  conditions  of  the 
mucous  membrane  (pharyngitis) .  Circumscribed 
swellings  indicate  the  presence  of  abscesses  and  tumors. 

Palpation.  Increased  temperature  and  sen- 
sitiveness indicate  acute  inflammation  which  may  be 
either  diffuse  (pharyngitis)  or  circumscribed  (development 
of  abscesses) ,  The  c  o  n  s  i  '=  t  e  n  c  y  is  firm,  yet  yielding ; 
even  in  abscess  formation  distinct  fluctuation  is  rarely  pres- 
ent here.  Circumscribed  painless  swellings  of  firm  consist- 
ency indicate  the  presence  of  tumors,  usually  melanosarcoma 
in  old  gray  horses  and  actinomycoma  in  cattle'.  Palpation 
of  the  esophagus  serves  to  detect  the  presence  of  for- 
eign bodies,  mostly  observed  in  cattle  in  the  form  .of  pieces 
of  potatoes,  apples,  corn  cobs,  etc.  Esophageal  diverticula 
and  stenoses  cause  periodically  recurring  occlusions  of  the 
esophagus.  Ingestion  of  food  causes  the  esophagus  to  dis- 
tend— sausage  like.  Such  animals  cease  eating,  or,  when 
they  attempt  to  eat  or  drink,  regurgitation  of  the  ingested 
mass  through  the  nostrils    takes  place. 

Examination  with  a  probe  or  probang  has  no  special 
value ;  the  dilated  esophagus,  regurgitation,  vomiting  of 
food  and   symptoms  of  choking  are   sufficient  to  base   upon 


DIGESTIVE    APPARATUS.  143 

them  the  diagnosis  diverticulum  and  stenosis,  two  conditions 
usually  coexisting.  On  the  other  hand,  the  fact  that  a  pro- 
tang  can  be  passed  freely  through  the  esophagus  does  not 
exclude  the  presence  of  these  conditions. 

IV.     Rumination. 

Rumination  is  a  specific  physiological  act  of  the  digestive 
apparatus  of  ruminants.  These  animals  feed  by  taking  up  food 
hurriedly  and  swallowing  it  after  little  or  no  mastication.  After 
ingestmg  a  sufficient  amount  of  food  in  this  manner,  the  latter, 
which  by  this  time  has  become  partly  macerated  by  the  saliva 
which  accumulated  with  it  in  the  rumen,  is  carefully  rcmasticated. 
During  this  act  the  animals  prefer  a  recumbent  position.  The 
food  is  forced  into  the  mouth  by  a  contraction  of  the  secona 
stomach  or  reticulum  into  which  it  previously  passes  from  the 
rumen.  Every  cud  is  subjected  to  about  60  masticatory  move- 
ments and  is  then  re-szcallozi'cd,  this  time  passing  directly  into 
the  omasum  and  abomasum  or  true  stomach  through  the  esoph- 
ageal groove.  The  whole  act  of  rumination  requires  from  one 
to  two  hours.  When  cattle  are  driven  or  oxen  put  to  work  before 
they  had  time  to  finish  ruminating,  this  act  is  temporarily  sus- 
pended to  be  resumed  at  the  next  period  of  rest. 

Slight  disturbances  of  the  act  of  rumination  can  as  a 
rule  not  be  recognized  as  such. 

Considerabledeviations  from  the  nor- 
mal or  complete  suppression  of  rumination  alone  are  definite 
signs  of  disease. 

Jn  the  beginning  disturbances  in  rumination  due  to  dis- 
ease manifest  themselves  by  a  •  reduction  in  the  number  of 
cuds  chewed  in  a  certain  time,  by  the  number  of  masticatory 
movements  applied  to  each  cud  before  b^ing  swallowed  and 
by  ihe  rapidity  with  which  the  animal  masticates. 

The  severity  of  the  disease  corresponds  to  the  degree  to 
which  rumination  is  interrupted.  In  severe  diseases  rumina- 
tion ceases  entirely. 

Rumination  is  disturbed  in: 

a.  [All  severe  febrile  and  painful  affections,  surgical 
diseases.] 

b.  Gastric  and  intestinal  disturbances,  especially  over- 
loading and  paralysis  of  the  paunch. 


144  CLINICAL    DIAGNOSTICS. 

c.  Traumatic  inflammation  of  the  stomach  and  dia- 
phragm. 

d.  [All  cachectic  diseases.] 

e.  [Many  cerebral  diseases.] 

Eructation  or  belching  occurs  normally  in  ruminants 
only.  This  consists  in  audible  expulsion  of  paunch  gases 
through  the  oesophagus  and  mouth.  [Eructations  become 
distinctly  audible  and  abnormally  frequent  during  fermentation 
processes  in  the  paunch,  slight  tympanitis,  etc.  Sometimes 
they  are  accompanied  by  disagreeable  odors  (fermentations) 
but  the  character  of  the  food  also  plays  a  role  here  (onions).] 

V.     Vomiting. 

Vomiting  is  a  reflex  (involuntary)  spasmodic  evacua- 
tion of  the  stomach  or  paunch  contents  through  the  mouth 
cr  nasal  passages.  This  act  is  assisted  by  simultaneous  con- 
traction of  the  abdominal  and  inspiratory  muscles.  Imme- 
diately preceding  the  act  of  vomiting  animals  make  a  deep 
inspiratory  movement.  Vomiting  is  caused  by  indirect 
(rarely  direct)  stimulation  of  the  vomiting  center  in  the 
medulla  oblongata. 

The  ease  with  which  vomiting  occurs  in  our  domestic 
animals  varies  with  the  species  according  to  the  anatomical 
construction  and  the  degree  of  fullness  of  the  stomach.  Car- 
nivora,  pigs,  and  birds  vomit  most  readily  and  with  greatest 
ease,  ruminants  less  so.  Horses  rarely  vomit.  This  is  ex- 
plained by  the  anatomical  structure  and  position  of  the  stom- 
ach. [The  stomach  of  the  horse  is  comparatively  small  and 
even  when  filled  does  not  always  come  into  contact  with  the 
floor  of  the  abdomen,  hence  is  not  easily  afifected  by  abdom- 
inal contractions.] 

Further,  the  spiral  arrangement  of  the  muscular  coats, 
insertion  of  the  esophagus  at  the  middle  of  the  stomach,  its 
contracted  and  thickened  wall  at  the  point  of  insertion  (in 
contrast  to  the  funnel  shaped  thin  walled  structure  of  this 


DIGESTIVE    APPARATUS.  145 

organ  in  other  animals)  and  the  large  fundus  of  the  horse's 
stomach  must  be  considered  in  this  connection. 

A  vigorous  contraction  of  the  stomach  will  serve  to  over- 
come these  obstacles  and  vomiting  may  occur  in  the  horse. 
In  such  cases,  however,  there  is  always  danger  of  rupture,  of 
the  organ.  This  is  the  usual  result  when  the  stomach  is  well 
filled  with  food.  Vomiting  in  the  course  of  colic  is  therefore 
always  a  serious  symptom.  If.  hozvcvcr.  tJic  stomach  of  the 
Jiorsc  is  moderately  filled  zcith  fluid  contents,  a  rupture  need 
not  occur.  In  such  cases  the  act  of  vomiting  is  usually  not 
caused  by  an  overloaded  stomach  but  by  direct  stimulation  of 
the  vomiting  center.  (Chloroform  narcosis,  hemorrhages  and 
inflammations  near  the  medulla). 

Vomiting  is  a  1  w  a  \'  s  a  s  y  m  p  t  o  m  of  d  i  s  - 
ease    and  occurs  under  the  following  conditions : 

a.  During  the  presence  of  foreign  bodies  in  the  larynx 
or  at  the  base  of  the  tongue :  pieces  of  bone,  fish  bones, 
needles,  feathers,  etc..  also  when  tough,  stringy  mucus  col- 
lects in  this  region  in  the  course  of  pharyngitis  and  laryngitis. 

b.  Obstruction  of  esophagus. 

c.  Gastric  affections,  overloading  of  stomach,  gastritis, 
and  in  certain  poisonings. 

d.  Intestinal  affections,  such  as  prevent  the  normal 
progress  of  food  masses  through  the  lumen  of  the  intestine 
and  thus  provoke  antiperistaltic  movements  which  cause  the 
stomach  to  become  distended  with  intestinal  contents,  irrita- 
tion of  its  mucous  membrane,  and  vomiting. 

The  character  of  the  vomited  material  may  often  serve  to 
determine  the  cause  of  the  act  and  the  origin  (stomach  or  in- 
testine) of  the  ejected  mass. 

VI.     The  Abdomen. 

Examination  of  the  abdomen  is  conducted  according  to 
the  following  general  rules. 

a.     Inspection.     The  volume  or  circumference  of  the 


146  CLINICAL    DIAGNOSTICS. 

abdomen  in  domesticated  animals  is  subject  to  great  variations 
and  great  care  must  be  exercised  here  in  diagnosis.  For  clini- 
cal purposes  the  size  of  the  abdomen  must  always  be  con- 
sidered in  connection  with  the  general  condition  of  the  animal, 
its  general  make  up.  feed,  care.  etc.  Animals  habitually  kept 
on  voluminous  food  in  ample  abundance  develop  a  voluminous 
abdomen.  A  good  plan  is  to  inquire  of  the  owner  as  to  the 
former  or  usual  condition  of  the  animal  in  this  respect.  Cir- 
cumscribed enlargements  are  usually  of  interest  from  a  sur- 
gical point  of  view. 

Abnormal  distention  of  the  abdomen  may  be  due  to: 

1.  Pregnancy ;  the  form  of  the  abdomen  becomes  barrel 
shaped — increasing  bilaterally. 

2.  Accumulation  of  abnormal  quantities  of  food  in  the 
digestive  tract  (in  horses  the  cecum  and  colon,  in  ruminants 
the  paunch  and  other  stomachs,  in  dogs  the  stomach ) .  In 
these  cases  the  distention  is  due  either  to  increased  consump- 
tion of  food  (overfeeding)  or  to  accumulation  of  food  taken 
in  normal  quantities  during  inactivity  of  the  bowels  (constipa- 
tion). In  these  cases  the  normal  tympanitic  tone  is  replaced 
by  a  dull  one. 

3.  The  accumulation  of  gases  produced  by  fermenting 
food.  In  this  case  the  distention  is  in  an  upward  direction, 
the  hollow  of  the  flank  is  raised,  and  the  abdominal  walls  be- 
come distended  (tympanitis,  bloat).  The  rapid  production  of 
gas  may  be  due  to  the  character  of  the  food  [legumes,  cruci- 
fera,  etc.]   or  to  suspended  activity  of  the  bowels. 

4.  Accumxdatio)i  of  fluid  (transudate  and  exudate)  in 
the  peritoneal  cavity.  This  is  occasionally  seen  in  dogs,  rarely 
in  horses.  In  this  case  the  distention  is  in  a  downward  direc- 
tion, symmetrical  and  bilateral,  fluctuation  is  observed  and 
percussion  reveals  a  dull  area  bounded  above  by  a  horizontal 
line.  When  a  dog  thus  affected  is  raised  to  a  vertical  position 
ihe  dull  area  is  shifted   (ascites). 


DIGESTIVE   APPARATUS. 


147 


5.  Tumors  in  the  abdomen;  liver  (ecchinococci  and  car- 
cinoma), spleen   (leukemia),  glands,  etc. 

6.  Dropsy  of  foetal  membranes. 

Abnormal  reduction  in  size  of  the  abdomen  may  he  due  to: 
1.     Long  continued  starvation,  or,  if  in  spite  of  good  care, 
abundant  food  and  sufficient  rest  an  animal  shows  this  symp- 
tom, we  may  conclude  that  lack  of  appetite  is  at  fault  (digest- 
ive disorders). 


Fig.  36. 
Dorsal  and  Ventral  limits  of  area  of  percussion.     —  -  —  Attachment  of  diaphragm 
to  ribs.     N.  Right  kidney.     L.  Liver.     H    Reticulum. 
B.  Manyplies.     Labm.  Stomach. 


2.  In  serious  subacute  diseases;  in  such  sases  the  ani- 
mal's general  condition  may  still  be  good. 

3.  During  or  following  severe  diarrheas,  or  after  colic 
when  strong  purgatives  were  prescribed. 

4.  J^iolent  contraction  of  the  abdominal  muscles  in  pain- 
ful affections  of  the  hind  legs. 


148  CLINICAL    DIAGNOSTICS. 

Palpation.  The  object  of  palpation  is  to  ascertain  the 
consistency  of  the  bowel  contents  and  whether  or  not  painful 
conditions  exist.  In  ruminants  the  peristaltic  motion  of  the 
paunch  can  also  be  observed  by  palpation.  Palpation  of  the 
bowels  per  rectum  is  of  especial  value  in  large  animals. 

In  horses  the  abdominal  walls  are  thick  and  tense ;  this 
and  the  fact  that  during  aji  examination  the  animals  frequent- 
ly contract  the'ir  abdominal  muscles  increases  the  difficulty  of 
arriving  at  accurate  results  in  judging  of  the  condition  of 
the  abdominal  organs,  their  contents,  etc.  In  cattle  the  ab- 
dominal walls  are  thinner,  hence  the  results  of  palpation  are 
more  accurate  and  satisfactory ;  in  sheep  this  is  true  to  a  still 
greater  degree. 

Dogs  habitually  contract  the  abdominal  walls  when  these 
are  manipulated,  but  soon  relax  them  again.  In  dogs  both 
sides  are  palpated  simultaneously,  and  by  exerting  pressure 
from  both  sides  toward  the  median  line  the  entire  abdominal 
cavity  may  be  thoroughly  examined. 

Palpation  serves  in  the  first  place  to  inform  us  as  to  the 
degree  of  contraction  (the  tenseness  of  the  abdominal  walls 
and  the  consistency  of  the  bowel  contents ;  the  latter  should  be 
soft  and  easily  compressible.  If  impressions  are  made  by  pres- 
sure they  should  soon  be  effaced  by  the  effects  of  peristalsis. 
Large  quantities  of  fluid  bow£l  contents  produce  fluctuation. 
NeoftDrraatlons  (tunaors)  are  Tecognized  by  the  extreme  resist- 
ance tliey  oif er  to  pressure.  In  dogs  accumulated  fecal  masses 
[and  intussuscepted  intestines]  can  readily  be  felt.  Foreign 
bodies  in  the  stomach  and  intestines  can  also  be  detected  by 
palpation  providing  the  normal  bowel  contents  are  previously 
•evacuated   [medicines  or  clysters]. 

Another  object  of  palpation  is  to  ascertain  painful  condi-, 
tions  ,or  abnormal  sensitiveness.  Even  healthy  horses  are 
often  extremely  sensitive  to  pressure  exerted  on  the  abdomen 
and  become  restless  when  subjected  to  such  an  examination. 
Care  must  therefore  be  observed  not  to  mistake  these  symp- 


DIGESTIVE   APPARATUS.  I4^ 

toms  for  something  more  serious.  In  cattle  it  is  dififerent,  be-- 
cause  abnormal  sensitiveness  in  these  animals  always  points  to 
the  existence  of  important  lesions. 

Sensitiveness  to  pressure  between  the  6th  and  8th  ribs 
(opposite  the  reticulum)  points  to  the  possibility  of  an  injury 
to  the  diaphragm  from  a  foreign  body  that  penetrated  the 
reticulum.  In  acute  affections  of  the  true  stomach  cattle 
evince  symptoms  of  pain  on  palpation  of  the  hypochondriac 
region.  Palpation  of  the  right  flank  in  cattle,  when  intussus- 
ception of  the  small  intestine  exists,  is  also  attended  with 
symptoms  of  pain.  Foreign  bodies  in  the  intestines  of  dogs' 
produce  symptoms  of  pain  when  pressure  is  exerted. 

In  cattle  the  peristaltic  movements  of  the  paunch  are  an' 
important  consideration.  Normally  these  can  be  felt  in  the" 
hollow  of  the  left  flank  at  the  rate  of  about  two  per  minute. 
The  food  masses  are  moved  from  below  upward  and  toward 
the  right  side.  Every  contraction  of  the  paunch  is  attended- 
by  a  slight  rise  in  the  hollow  of  the  flank  followed  by  a  some-- 
what  more  sudden  drop  or  depression.  Imperfect  or  slowed 
movements  of  the  paunch  point  to  the  existence  of  some  patho- 
logical condition  (overfeeding,  tympanitis,  paresis  of  the 
paunch,  peritonitis,  adhesions  of  the  paunch  with  the  abdomi- 
nal wall). 

Palpation  of  the  bowels  per  rectum.  This-  is  possible 
only  in  the  comparativel)'  large  rectum  and  roonly  pelvis  of  the 
horse  and  ox,  but  on  the  other  hand  the  proportions  are  so 
large  here  that  only  a  part  of  the  abdominal  region  can  be  thus 
explored.  In  the  region  within  our  reach  we  can  determine 
position  and  contents  of  the  abdominal  organs,  also  the  pres- 
ence of  foreign  bodies  arid  tumors. 

Method  of  procedure.  To  make  a  thorough  examina- 
tion it  is  often  necessary  to  introduce  the  arm  full  length. 
A  shirt  without  a  sleeve  can  be  worn  to  advantage  on  such  an 
occasion.  [After  carefully  paring  the  finger  nails]  the  arm 
should  be  well  covered  with  oil,  or  soap  (castor  oil  answers  the 


150  CLINICAL    DIAGNOSTICS. 

purpose  well)  and  then,  with  the  tips  of  the  fingers  forming  a 
cone,  the  hand  is  carefully  introduced  into  the  rectum.  Dur- 
ing the  examination  the  animal's  head  (if  a  horse)  is  held  up, 
and  the  forefoot  on  the  side  where  the  operator  stands  is 
raised,  by  an  assistant.  Nervous  or  excitable  horses  can  be 
secured  with  a  twitch  or  the  operator  can  protect  himself 
against  kicks  by  having  the  animal  standing  close  to  a  stable 
partition,  the  operator  standing  on  the  opposite  side.  The  left 
half  of  the  abdominal  cavity  can  be  examined  most  satisfac- 
torily with  the  right  hand,  the  right  half  with  the  left  hand. 
Since  perforations  can  be  produced  it  is  advisable  to  proceed 
with  the  utmost  care  in  making  rectal  examinations. 

If  accumulated  food  masses,  contraction  of  the  rectum,  or 
the  presence  of  gases  retard  the  easy  introduction  of  the  hand, 
simultaneous  infusions  of  water  should  be  given  to  facilitate 
the  operation.  It  is  always  a  good  plan  to  insert  the  arm 
nearly  its  full  length  before  beginning  our  examination.  In 
this  way  a  long  piece  of  the  rectum  slips  over  the  arm  and 
there  is  less  danger  of  pulling  or  straining  the  mesentery.' 
This  danger  decreases  as  the  length  of  the  mesentery  increases 
anteriorly. 

Exploration  per  rectum  is  indicated  in  chronic  colic  and 
in  all  cases  of  colic  in  stallions  and  cattle.  Palpation  may 
serve  to  determine  the  following  points : 

I.  Fullness  and  position  of  the  bowels. 
The  separate  regions  of  the  intestines  can  be  definitely  recog- 
nized onlv  when  they  are  filled  with  food.  Mere  distention 
with  gases  does  not  always  enable  us  to  recognize  with  cer- 
tainty the  identity  of  parts.  When  the  bowels  are  empty  or  only 
.  partially  filled  with  fluids  or  gases  it  may  be  impossible  to  dis- 
tinguish between  the  large  and  the  small  intestine.  The  longi- 
tudinal muscular  bands  of  the  large  intestine  of  the  horse  are 
the  only  means  of  differentiation,  and  these  must  be  sought. 
Manual  exploration  per  rectum  enables  us  to  recognize  food 


DIGESTIVE    APPARATUS.  151 

accumulations  or  impactions  in  the  following  divisions  of  the 
bo\^els : 

a.  Impaction  of  the  Hoating  colon.  This  is  of  frequent 
occurrence  in  its  posterior  region  and  can  then  be  easily  rec- 
ognized (rectal  paralysis)  ;  constipation  in  the  floating  colon  is 
recognized  by  the  nodular  character  of  the  surface  and  the  sin- 
uous course  of  the  bowel.  Its  volume  is  appreciably  less  than 
that  of  the  colon  or  cecum. 

b.  Impaction  of  left  colon.  When  well  filled  with  im- 
pacted food  masses  the  pelvic  flexure  projects  into  the  pelvic 
cavity  and  frequently  toward  the  right  hand.  This  flexure  is 
recognized- by  its  great  volume,  its  curvature  and  the  short 
mesentery  uniting  the  two  superposed  layers  of  the  left  colon. 

c.  Impaction  of  cecum.  The  base  of  the  cecum  is  situ- 
ated in  the  upper  portion  of  the  right  flank  and  is  attached  to 
the  spinal  column  by  means  of  a  mesenteric  fold  and  the  pan- 
creas. When  distended  with  food-masses  its  great  curvature, 
which  is  smooth,  projects  almost  to  the  right-hand  border  of 
the  pelvis.  The  small  curvature  can  also  be  recognized  and 
serves  to  identify  the  organ.  The  longitudinal  muscular  bands 
can  also  be  felt. 

d.  Impaction  of  the  ileum.  This  usually  occurs  near  the 
ileo  cecal  valve.  The  impacted  intestine  courses  transversely 
from  the  left  to  the  right  side  of  the  flank.  It  can  be  recog- 
nized by  its  sausage-like  form  which  can  be  almost  encircled 
by  the  hand. 

The  following  dislocations  or  displacements  of  the  intes- 
tine can  be  diagnosed : 

a.  Incarceration  in  inguinal  canal;  most  frequently  ob- 
served in  stallions.  The  intestine  can  be  felt  about  two  or 
three  inches  in  front  of  the  pubic  bone  and  four  or  five  inches 
to  the  right  or  left  of  the  median  line  where  it  seems  to  be 
firmly  attached.  A  pull  exerted  at  this  point  causes  the  ani- 
mal to  evince  signs  of  pain.  Simultaneous  examination  of  the 
scrotum  (external)  clinches  the  diagnosis. 


152  CLINICAL    DL\GNOSTICS. 

b.  Peritoneal  hernia  or  so-called  gut  tie  of  the  ox.  A 
loop  or  knuckle  of  intestine  can  be  felt  at  the  anterior  margin 
of  the  ileum,  retained  between  the  latter  and  the  vestige  of  the 
spermatic  cord.  The  doughy  painful  swelling,  held  in  posi- 
tion by  the  tense  cord  which  is  situated  anteriorly,  are  the 
characteristics  of  this  condition. 

c.  Invagination  of  the  small  intestine  in  cattle.  This 
condition  is  recognized  by  the  presence  of  a  firm  but  elastic 
sausage-like  mass  in  the  lumen  of  the  intestine,  terminating 
abruptly  posteriorly  but  insensibly  anteriorly  where  food 
masses  have  accumulated.  The  length  of  this  mass  varies 
with  the  extent  of  the  invagination. 

d.  Torsion  of  the  left  layers  of  the  colon  in  the  horse. 
In  this  condition  the  tense  mesentery  can  be  felt  coursing 
downward  and  to  the  left  immediately  in  front  of  the  entrance 
to  the  pelvis  and  just  below  the  -ith  lumbar  vertebra.  A  pull 
exerted  on  the  mesentery  produces  symptoms  of  pain.  A  sec- 
ond tense  strand  can  be  felt  in  the  umbilical  region  (a  longi- 
tudinal band  of  the  inferior  layer  of  the  colon  which  courses 
from  left  to  right).  The  pelvic  flexure  has  shifted  from  its 
normal  position. 

II.  Enteroliths  (stones  and  concretions  in  the  in- 
testines) can  be  detected  only  when  the  intestines  are  compara- 
tively empty.  The  presence  of  large  masses  of  food  interferes 
with  their  recognition.  It  is  best,  therefore,  when  these  .are 
suspected,  to  free  the  intestines  of  their  contents  with  a  purge 
before  proceeding  with  the  examination. 

III.  Tumors  and  tuberculous  tumefactions  of  the 
lymphatics  can  be  recognized  only  when  they  have  a  certain 
size,  e.  g.,  that  of  a  hazelnut,  and  here  too  a  purge  must  be 
given  to  remove  solid  fecal  masses  before  exploration  begins, 
otherwise  mistakes  are  easily  made. 

Percussion  of  the  abdomen.  Topographical  anatomy. 
The  position  of  the  various  portions  of  the  intestinal  tract 
varies  considerable  according  to  their  degree  of  fullness ;  we 


DIGESTIVE   APPARATUS.  153 

can,  therefore,  not  define  the  outlines  of  these  organs  with 
any  degree  of  exactness  in  the  living  animal.  In  a  general 
way,  however,  these  outlines  may  be  defined  as  follows : 

The  right  portions  of  the  colon  and  the  cecum  occupy  the 
right  side  of  the  abdominal  cavity.  We  may  be  aided  in  de- 
finmg  the  position  of  the  various  portions  of  the  intestinal 
tract  by  drawing  a  line  along  the  abdominal  border  of  the 
area  of  percussion  for  the  lung,  and  a  second  line  along  the 
course  of  the  last  rib  and  extending  over  the  cartilages  of  the 
floatmg  ribs;  between  these  two  draw  a  third  (horizontal)  line 
at  the  middle  of  the  body  of  the  animal.  This  outlines  three 
areas  on  the  right  side  of  the  abdomen.  The  anterior  (lower) 
area  is  occupied,  in  the  main,  by  the  right  upper  portion  of  the 
colon,  which  occupies  a  position  just  behind  the  diaphragm 
The  ventral  portion  of  the  colon  lies  opposite  the  cartilages  of 
the  false  ribs,  in  the  region  of  the  8th  to  the  17th  ribs,  about 
half  of  Its  volume  being  situated  above  and  the  other  half 
below  the  cartilages. 

The  cecum  occupies  the  whole  of  the  third  or  posterior 
area  as  well  as  the  upper  anterior  area  as  far  as  the  14th  rib 
The  small  intestines  and  the  floating  colon  occupy  a  position 
behind  the  cecum  beginning  at  a  vertical  line  dropped  from 
the  external  angle  of  the  ilium. 

On  the  left   side    (Fig.   32,  p. )    (in  the   horse)    the 

small  intestine  and  the  floating  colon  occupv  the  region  of 
the  upper  two  areas  while  the  third,  or  lower,  area  is  occupied 
by  the  left  portion  of  the  colon,  extending  up  to  the  ilium.  The 
lower  portion  of  the  colon  occupies  the  greater  area  of  the 
abdominal  wall,  the  'upper  portion  being  placed  more  toward 
the  median  line  of  the  abdomen,  but  approaching  the  abdominal  • 
wall  as  It  courses  forward,  touching  it  through  the  medium  of 
the  diaphragm  between  the  Tth  an.d  11th  ribs. 

By  careful  observation  of  their  topographical  relationship, 
and  with  the  aid  of  percussion,  we  can  readily  determine  the 


154  CLIXICAL    DIAGNOSTICS. 

character  of  the  contents  of  the  various  sections  of  the  intes- 
tinal tract. 

As  a  rule  the  stomach  and  intestines  contain  a  moderate 
quantity  of  gases  which  distend  their  walls  only  slightly; 
hence  percussion  produces  a  tympanitic  sound.  In  the  paunch 
of  cattle  and  the  large  intestine  of  the  horse  where  food 
masses  accumulate,  the  sound  is  at  times  dull  tympanitic  or 
even  dull.  (Topography  of  bowels  at  left  side  in  the  horse; 
see  Fig.  — ). 

Abnormal  accumulations  of  food  masses  in  the  cecum 
and  colon  give  rise  to  a  dull  sound  and  a  sensation  of  resist-- 
ance  to  the  finger  or  pleximetric  hammer  at  points  on  the  ab- 
dominal wall  opposite  them.  If  the  accumulation  of  gases 
■causes  the  bowel  walls  to  distend  abnormally  and  become 
tense,  a  clear  sound  is  produced,  a  sound  resembling  that  pro- 
duced by  the  healthy  lung,  only  clearer  and  louder  because 
large  air  chambers  are  present.  (In  the  lungs  the  air  cham- 
bers are  small). 

Bilateral  dullness,  limited  above  by  a  horizontal  line,  is 
observed  when  fluids  collect  in  the  abdomen  (ascites).  This  is 
most  frequent  in  the  dog ;  raising  the  animal  to  a  vertical 
position  shifts  the  dull  area  accordingly. 

Auscultation  of  the  abdomen.  The  observation  of  the 
various  sounds  produced  by  the  moving  along  of  the  intestinal 
■contents  has  for  its  objects  the  determination  of  the  character 
of  the  movements  of  the  bowels.  The  sounds  are  produced  by 
the  onward  movement  of  the  solid,  liquid  and  gaseous  contents 
of  the  bowels.  The  gases  particularly  produce  distinctly  audi- 
ble sounds.  In  the  absence  of  intestinal  contents  sounds  are 
not  produced  by  peristaltic  motion. 

The  character  of  the  sounds  is  determined  by  the  consist- 
ency of  the  intestinal  contents  and  by  the  quantity  of  gases 
present.  Hence :  the  sounds  of  the  small  intestine  are  those 
•of  flowing  liquid,  gurgling,  and  splashing;  the  sounds  of  the 
large  intestine  rumbling,  cooing,  and  tumbling. 


DIGESTIVE   APPARATUS. 


155 


The  intensity  of  the  sounds  corresponds  to  the  intensity 
of  the  bowel  movements,  and  we  distinguish  lively,  weak, 
hardly  audible,  short  and  prolonged  sounds  or  noise. 

None  of  the  intestinal  sounds  are  continuous,  they  are 
always  interrupted  by  quiet  intervals,  but  in  healthy  animals 


Fig.  37. 

Dorsal  and  Ventral  limits  of  area  of  percussion.    —  -  —  Attachment  of  diaphragm 

to  ribs.     Coec.  Coecum.    v.  c.  Ventral  fold  of  the  colon, 
d.  c.  Dorsal  fold  of  the  colon. 

these  intervals  are  never  long.     Practice  in  ausculta'tion  is  of 
course  necessary  to  enable  us  to  judge  correctly. 

In  disease  quantitative  as  well  as  qualitative  deviations 
from  the  normal  occur.  The  sounds  may  be  absent  altogether 
in  certain  regions,  e.  g.,  the  small  intestine  may  have  a  lively 
peristaltic  motion  while  the  large  intestine  remains  at  rest. 
Intestinal  sounds  are  reduced  or  diminished: 
1.  In  impaction,  constipation  and  tympanitis,  a  paralytic 
condition  resulting  from  overdistention  and  overloading 
(colic). 


156  CLINICAL    DIAGN'OSTICS. 

2.  In  spasmodic  contraction  of  the  small  intestine  in  the 
course  of  spasmodic  and  rheumatic  colic. 

3.  In  persistent  diarrhea  when  the  intestinal  contents 
are  scanty. 

4.  In  severe  iriflammatory'  cdriditions  ( because  peristalsis 
is  then  more  or  less-  suspended  and  the  intestinal"  contents  are 
scanty)   (ent'gritis,  peritonitis). 

V^ery  lively  and  loud  intestinal  sounds  occur  in  all  cases 
of  slight  stimulation,  especially  when  the  latter  is  produced  by 
laxative  food :  green  fodder,  raw  potatoes,  wheat  bran  [clover 
hay,  alfalfa,  etc]. 

The  sound  of  a  drop  of  zvafcr  falling  onto  a  metal  plate  or 
pan  is  sometimes  observed  and  belongs  to  a  class  by  itself. 
It  occurs  when  a  loop  of  intestine  is  greatly  distended  and 
the  fluid  contents  of  the  overlying  intestines  (small  intestines) 
is  forcibly  flung  against  it  and  causes  its  walls  to  vibrate.  The 
presence  of  this  sound  indicates  that  a  loop  of  intestine  is  at 
rest  and  that  it  is  distended  with  gas. 

VII.     Intestinal  Discharges  or  Evacuations, 

The  quality  and  quantity  of  the  discharges  depend  in  the 
main  on  the  kind  and  quantity  of  the  food.  The  amount  of 
water  imbibed  has  little  or  no  influence  on  the  consistency  of 
the  discharges.  The  beginner  must  make  an  objective  study 
of  the  character  of  the  discharges  of  different  animals  on  vari- 
ous foods,  and  in  particular  cases  make  comparisons  with  the 
discharges  of  other  animals  kept  under  the  same  conditions  in 
the  same  stable.  There  are  many  diseases  in  which  the  char- 
acter of  the  bowel  discharges  is  of  very  great  importance. 

a.  Defecation.  The  act  of  defecation  is  accompanied  by  an 
arching  of  the  back  with  hind  legs  spread  and  slightly  advanced; 
dogs  assuming  a  crouching  position.  This  is  followed  by  a 
deep  inspiration,  fixing  of  the  thoracic  walls,  contraction  of  the 
abdominal  and  intestinal  muscles  and  relaxation  of  the  sphinctei 
of    the    anus. 

Defecation  is  difficult  when  the  feces  are  dry  or  hard 
(constipation).  Continued  rest  after  and  during  periods  of 
heavy  feeding  may  lead  to  an  accumulation  of  bowel  contents 


DIGESTIVE   APPARATUS.  I5y 

or  even  to  constipation.     \'oIuntary  defecation  is  almost  im- 
possible when  paralysis  of  the  rectum   exists,   in   such   ca  es 
he  ag:tat,on  of  the  body  during  locomotion  causes  the    e 
to  be  passively  discharged  through  the  gaping  anus 

InvolnuMry  evacuations  of  the  bowels  occur  in  cerebral 
spasms  and  m  paralysis  or  relaxation  of  the  anus.  The  latter 
IS  common  m  the  course  of  severe  diarrheas,  here  the  semi- 
liquid  feces  flow  down  on  the  legs 

Defecation  is  painfrd  in  the  course  of  painful  inflamma- 
tory conditions  m  the  abdominal  cavity  r  intestine,  periton- 
eum) diaphragm  or  abdominal  walls.  These  conditions  all 
mrfere_  with  the  normal  contrac^on  of  the  abdominal  mus- 

fbonesT"^  .f   ""'  °'   '^'^^^^^°°-      '^  ^°^^    ^--^-   bodies 
(bones)    in   the   intestines,   and  obstructions   bv   agglutinated 
hai.  at  the  anusof  long  haired  dogs,  are  particularTv  tro'ue 
some.     The  patients  groan,  cry  or  howl  during  attempts  at 
defecation;  they  avoid  the  act  as  much  as  possible  and' L 
bring  on  constipation. 

b.  Frequency  of  defecation.  Carnivora  defecate  once 
or  twice  daily,  herbivora  much  more  frequently;  horses  8-10 
times,  ,,ttle  12-18  times.  These  figures  are  increased  by 
bodily  exercise-particularly  in  horses  that  travel  much. 

When  the  normal  frequency  of  defecation  is  reduced,  we 
say  the  animal  is  constipated.  This  is  mostly  the  result  of 
diminished  peristaltic  motion  which  is  also  attended  with  in- 
creased absorption  of  fluids.  Constipation  mav  result  from 
impaction._  occlusion,  and  dislocation  of  the  intestine,  first 
stages  of  intestinal  catarrhs,  inflammations,  etc.     Constipation 

withn%^""''^fil  '''T°"  "^  '°^'^'  ''  ^"^>'  °^^"^'  however, 
without  any  other  cohc  symptoms.  In  ruminants  the  ingesta 
are  usually  retained  or  retarded  in  the  paunch  and  omasum! 
rarely  m  the  intestines. 

The  term  diarrhea  is  applied  to  frequent  and  usuallv 
copious  evacuations  of  liquid  or  semi-liquid  feces;  it  occurs 
m  all  irritated  conditions  of  the  intestinal  mucous  membrane 


158  CLINICAL    DL\GXOSTICS. 

and   is  caused  by   feed,   catarrh   and   inflammation.      Psychic 
disturbances  may  lead  to  diarrhea  by  reflex  action. 

c.  Volume  of  feces.  Here  we  must  distinguish  be- 
tween the  amount  passed  at  a  single  defecation  and  the  total 
for  a  day.  Well  fed  horses  (stable)  pass  2  to  4  lbs.  at  each 
act,  20  to  30  lbs.  per  day.  In  acute  and  in  chronic  hydro- 
cephalus the  volume  of  the  evacuated  masses  as  well  as  the 
intervals  between  evacuations  is  increased.  The  evacuations 
are  increased  in  quantity  in  diarrhea  following  constipation, 
they  are  diminished  after  the  use  of  evacuants  and  after 
[prolonged  diarrhea],  during  constipation  and  when  animals 
are  underfed. 

d.  Consistency  and  form.  Under  normal  and  usual 
conditions  horses'  dung  is  evacuated  in  balls  of  a  regular 
form,  which  on  striking  the  ground  usually  break.  In  cattle 
the  dung  is  voided  in  the  form  of  a  semi-solid  mass  (porridge), 
which  flattens  out  upon  striking  the  ground.  Sheep  and  goats 
pass  small  firm  balls  resembling  the  fruit  of  the  bay-berry. 
Swine  and  dogs  pass  feces  somewhat  more  solid  than  those  of 
cattle  and  frequently  quite  hard.  In  all  animals  the  character 
of  th&  food  has  a  great  influence  on  the  appearance  of  the 
evacuations.  In  describing  the  dung  of  the  horse  we  use  the 
terms  hard,  firm,  or  loose  balls,  very  moist  balls,  thick  ^s^riicl- 
like  mass,  thin' gruel-like  mass,  Hiiid.  zvatery. 

Increased  firmness  or  hardness  of  the  feces  is  observed 
in  all  febrile  diseases,  in  constipation,  and  in  the  first  stages 
of  intestinal  catarrhs.  In  severe  febrile  diseases  of  cattle 
(malignant  catarrhal  fever)  and  in  obstinate  constipation  the 
feces  are  dry,  hard  and  resemble  peat  in  appearance. 

Decreased  firmness  or  abnormal  softness  of  the  feces 
occurs  in  all  forms  of  diarrheas,  intestinal  catarrh,  inflamma- 
tion (mycotic  and  septic),  dysentery  of  calves  [hog  cholera], 
influenza  of  the  horse,  severe  tubercular  affections  of  the 
mesenteric  lymph  glands. 


DIGESTIVE   APPARATUS.  159 

e.  The  color  of  the  feces  is  due  to  admixtures  of  bile, 
coloring  matter  in  the  food  (chlorophyll  in  herbivora.  haem- 
aglobin  in  carnivora)  and  secretions.  An  admixture  of  frag- 
ments of  bone,  in  dogs,  produces  a  light  gray  color.  An 
exclusive  milk  diet  produces  yellow  feces  (bile)  ;  green  fod- 
der produces  a  greenish  hue ;  oats,  straw  and  timothy  hay 
produce  a  yellowish  brown  color;  corn,  beans,  rye  (especially 
when  coarsely  ground)  produce  a  gray  or  yellowish  gray 
color.  In  cattle  the  diet  is  much  more  varied  than  in  the 
horse,  consequently  it  is  difficult  to  determine  a  normal  color. 
It  varies  from  a  distinct  green  (in  pastured  animals)  to  lighter 
and  darker  shades  of  endless  variety.  Concentrated  foods 
(Kraftf utter)   tend  to  produce  a  more  grayish  color. 

The  following  morbid  changes  may  be  observed: 

The  longer  the  ingesta  are  retained  in  the  intestine  the 
darker  they  become.  After  continued  constipation  the  feces 
of  horses  and  cattle  assume  a  blackish  brown,  peat-like  color. 

A  decreased  admixture  of  bile  (icterus)  produces  a  gray, 
or  light  gray  color  resembling  clay.  Admixtures  of  blood 
produce  a  red,  brownish  red  or  chocolate  color,  sometimes 
almost  black.  A  thorough  admixture  of  the  blood  with  the 
evacuated  contents  points  to  the  occurrence  of  a  hemorrhage 
in  the  anterior  portions  of  the  intestinal  tract  (hemorrhagic 
enteritis,  dysentery,  etc.).  If  the  hemorrhage  occurred  in 
the  rectum  the  blood  adheres  in  the  form  of  streaks  or  clots. 

Discolorations  are  produced  by  catarrhal  and  inflam- 
matory affections.  In  dysentery  of  calves  the  feces  are  gray 
or  grayish  white.  Some  medicines  produce  specific  colora- 
tions of  the  feces :  iron  produces  a  black,  calomel  a  green 
color. 

f.  Covering  of  the  feces.  In  herbivora  the  feces  are 
covered  with  a  thin  pellicle  of  mucus  which  gives  them  a 
shiny  appearance.  This  coating  of  mucus  increases  or  de- 
creases in  thickness  as  the  time  during  which  the  feces  are 
retained  in  the  intestine  is  increased  or  decreased.     In  intes- 


IGO 


CLINICAL    DIAGNOSTICS. 


tinal  diseases  attended  with  extensive  exudation  from  the- 
mucous  membrane  the  feces  are  not  only  coated  with  mucus 
but  are  mixed  with  it.  This  mucus  may  be  glossy,  colorless, 
yellowish  (bile)  or  gray  (epithelial  cells  and  white  blood 
corpuscles),  Flaky  or  fenestrated  coagulations  on  the  surface 
of  feces  have  their  origin  in  the  rectal  mucous  membrane 
(proctitis). 

g.     Odor  of  the  feces.    This  varies  with  every  species 
according  to  the   food.     Horse  dung  can   hardly  be   said  to 


#'f^    ■©:■    imc^i<^-i: 


\ 


-^'iAi-  s 


•^^i 


•X-  ci-r      / 


Eggs  of  Ascaris  megalocephala 


Fig.  38 
dung  of    horse.      Globular  i 
double  contour. 


form,  diameter  0.1  mm^ 


have  an  otTensive  or  repulsive  odor,  the  dung  of  the  ox  has 
an  odor  peculiar  to  itself,  and  the  feces  of  carnivora  stink. 
Horse  dung  has  a  sour  odor  in  digestive  disorders  when  con- 
centrated food  was  given  in  abundance.  The  feces  of  her- 
bivora  siink  or  have  a  foitl  odor  when  putrefactive  processes 
go  on  in  the  diseased  digestive  tract.  If  albuminous  exudates 
(blood)  are  present  under  these  conditions  the  odor  is  car- 
rion-like   (hemorrhagic   enteritis,   distemper   of   dogs). 


DIGESTIVE     APPARATUS.  161 

h.  The  chemical  reaction  of  the  feces  has  no  particular 
diagnostic  value.  Horse  dung,  as  a  rule,  has  an  acid  reaction, 
a  result  of  the  decomposition  processes  going  on  in  the  large 
intestine.  In  digestive  disorders  and  intestinal  catarrhs  the 
acidity  is  often  increased. 

i.  Composition  of  the  feces.  The  composition  of  the 
feces  as  far  as  food  particles  and  foreign  substances  are  con- 
cerned demands  careful  consideration.  In  the  first  place  the 
size  of  the  undigested  food  particles  must  be  considered,  this 
indicates   the  degree  of  mastication   or   rumination   to   whi^' 


Fig-.  39. 
Eggs  of  Distomum  hepaticum  in  dung-  of  sheep. 

they  were  subjected.  In  cattle  the  feces  should  consist  of  a 
homogeneous  mass;  coarse  particles  of  food  always  indicate 
insufficient  or  faulty  rumination:  overloading  of  paunch, 
paralysis  or  inactivity  resulting  from  inflammatory  afifections 
are  the  cause  of  the  latter.  In  horses,  on  the  other  hand, 
coarse  undigested  particles  of  food  occur  normally  in  the 
dung,  and  faulty  mastication  is  not  indicated  unless  the  coarse 


162  CLINICAL    DIAGNOSTICS. 

particles  are  very  numerous  and  whole  or  nearly  whole  grains 
of  ,corn,  etc.,  and  bits  of  straw  or  hay  can  be  recognized. 
The  cause  of  the  presence  of  coarse  particles  of  food  consists 
either  in  greedy  feeding  or  in  defective  molar  teeth.  The 
degree  of  the  defect  bears  a  direct  relation  to  the  degree  of 
coarseness  of  the  food  particles. 

Foreign  bodies  in  the  feces  of  horses  usually  con- 
sist of  sand,  and  in  sheep  we  find  wool. 

Inflammatory  products  consist  of  mucus, 
"'^ood,  pus.  croupous  membranes;  in  chronic  intestinal  catarrh 
^     cattle  we  often  find  small  clots  of  blood. 

In  cattle  and  calves  suffering  with  catarrhs  or  other  in- 
flammatory conditions  of  the  digestive  tract  the  soft  feces  fre- 
quently contain  numerous  gas  bubbles ;  these  are  due  to  gas- 
producing  putrefactive  organisms  which  are  particularly  active 
in  concentrated  foods  that  pass  rapidly  along  the  digestive 
tract. 

Anv  parasites  of  the  gastro-intestinal  tract  may  occa- 
sionallv  be  met  with  in  the  feces,  either  entire  (Ascarides, 
Oxyuris)  or  in  segments  (proglottides  of  tapeworms)  ;  some- 
times the  eggs  only  are  present  (Distoma  in  sheep  and  cattle). 
When  Distoma  are  suspected  a  microscopical  examination  of 
the  feces  should  be  made.  The  eggs  of  these  parasites  are 
yellowish  brown  oval  bodies  or  capsules  provided  with  a  lid. 
(0.15mm  long,  0.1mm  diameter). 

The  most  common  parasites  of  the  digestive  tract  are  as 
follows : 

Horse:  Gastrophilus  equi  and  hemorrhoidalis,  A>6caris 
megalocephala.  Strongylus  armatus  [tetracanthus],  Tenia 
mamillana,  perfoliata,  and  plicata. 

Cattle:  Amphistomum  conicum,  Ascaris  lumbricoides. 
Strongylus  radiatus  and  ventricosus.  Tenia  denticulata  and 
expansa,  Tricocephalus  affinis,  Strongylus  inflatus.  In  the 
bile  ducts :     Distomum  hepaticum  and  lanceolatum. 

Sheep:     Amphistomum    conicum.    Strongylus    contortus, 


DIGESTIVE     APPARATUS.  163 

liypostomus,  filicollis  and  cernuus.  Tenia  expansa,  Tricho- 
cephahis  affinis.  and  [Tenia  fimbriata].  In  the  bile  ducts: 
Distomum  hepaticum  and  lanceolatum,  and  [Tenia  fimbriata]. 

Goaf:  Strongylus  contortus,  hypostomns.  filicollis  and 
A'enulosus.   Trichocephalus  affinis.   Tenia  expansa. 

Pig:  Spiroptera  strongylina,  Trichina  spiralis,  Ascaris 
lumbricoides,  Echynorynchus  gigas,  Strongylus  dentatus.  Tri- 
cocephalus  dispar.  In  the  liver :  Distomum  hepaticum  and 
lanceolatum. 

Dog:  Tenia  echinococcus,  cenurus,  marginata,  serrata, 
cucumerina.  Bothriocephalus  cordatus  and  latus,  Ascaris  mys- 
tax,  Dochmius  trigonocephalus,  Trichocephalus  depressiuscu- 
lus. 

The  discharge  of  intestinal  gases  occurs  only  in  horses 
and  dogs ;  corn  and  green  feed  produce  these  gases  in  large 
quantities.  In  old  cows,  with  chronic  affections  of  the  rec- 
tum or  undue  laxness  of  the  sphincter  ani,  air  is  often  sucked 
in  during  the  act  of  expiration  and  expelled  again  at  inspira- 
tion, thus  producing  a  sound  as  though  intestinal  gases  were 
being  discharged. 

Addendum.  An  examination  of  the  liver  and  spleen  of 
domesticated  animals  is  usually  impracticable  and  in  fact  of 
little  importance  because  primary  diseases  of  these  organs  are 
rare.  An  enlarged  liver  in  the  dog  can  be  felt  in  the  region 
of  the  last  rib.  in  the  large  animals  palpation  of  the  liver  per 
rectum  may,  in  rare  instances,  give  valuable  information. 
AVhen  greatly  enlarged  the  spleen  in  the  horse  and  the  liver 
in  the  ox  can  thus  be  felt  and  tubercles,  echinococci  and 
tumors  recognized. 

Diseases  of  the  Digestive  Apparatus. 

a.     AI  o  u  t  h  ,     P  h  a  r  jMi  X     and     Esophagus. 

Stomatitis.  Here  the  morbid  changes  can  be  directly  ob- 
served; three  forms:  Stomatitis  catarrhalis,  st.  vesicularis,  st. 
ulcerosa. 

Ptyalism.  A  continued  discharge  of  large  quantities  of  saliva 
without  any  assignable  cause. 


164  CLINICAL    DIAGNOSTICS. 

Pharyngitis,  Angina  pharyngea.  More  or  less  fever  accord- 
ing to  the  character  of  the  inflammation.  Head  held  up,  neck 
stiff.  Appetite  present  but  mastication  and  especially  deglutition 
impaired.  Food  and  particularly  water  ejected  through  the  nose. 
Accumulation  of  saHva  and  food  in  the  mouth,  salivation;  foreign 
bodies  (food)  in  larj-n.x,  and  cough.  More  or  less  symptoms  ot 
laryngitis,  in  serious  cases  dyspnea  as  a  result  of  swelling  of 
laryngeal   mucous   membrane. 

Paralysis  of  esophagus  and  pharynx.  Dysphagia  paralytica, 
difficult   deglutition   and   al)sonce   of   intlammatory  sj-mptoms. 

Foreign  bodies  in  esophagus.  Most  frequent  in  cattle  (but 
also  observed  in  horses);  salivation,  inability  to  swallow,  choking, 
flow  of  saliva  from  nose;  tympanitis  in  cattle.  Foreign  body  in 
cervical  portion  of  esophagus  can  be   seen  or  felt. 

Esophageal  stenoses  and  diverticula  usually  develop  slowly 
and  graduall3^  Symptoms:  Sudden  interruption  in  feeding,  im- 
paction of  esophagus  with  food;  regurgitation,  choking.  Dis- 
charged   masses    are    foamy   but    not    sour. 

Diseases  of  the  teeth  in  animals  produce  trouble  in  feeding. 
Animals  begin  eating  with  apparent  appetite,  but  soon  stop  or 
continue  with  diminished  interest,  masticate  slowly  and  carefully, 
smack  their  lips,  pause,  salivate,  reject  partially  masticated  food, 
swallow  their  grain  whole,  masticate  roughage  poorly,  don't  eat 
.a  full  feed,  feces  contain  large  particles  of  food,  sometimes  there 
is  a  tendency  to  diarrhea.  The  following  conditons  of  the  teeth 
are  of  clinical  importance,  viz.,  sharp  teeth,  verj'  oblique  grinding 
surfaces  (shear-jaws),  an  undulating  or  irregular  set  of  teeth,  pro- 
jecting or  depressed  teeth;  caries  of  the  teeth,  tartar  deposits; 
periostitis  alveolaris,  tooth  fistulae,  neoformations  on  the  alveolar 
periosteum. 

b.     Gastric    and    Intestinal    Diseases    of   the    Horse. 

Acute  dyspepsia.  Lack  or  loss  of  appetite,  particularly  for 
grain;  animals  lick  cold  objects.  Thirst  is  increased,  buccal  mu- 
cous   membrane    dry,    animals    j-awn    frequently. 

Acute  gastro-intestinal  catarrh.  Usually  fever,  animal  is 
downcast,  conjunctiva  reddened,  sometimes  icteric,  .\ppetite  much 
impaired,  frequent  yawning,  buccal  mucous  membrane  reddened 
and  clammy;  feces  at  first  dry,  later  diarrheic;  urine  acid,  with- 
out   sediment,    contains    much    indican. 

Chronic  dyspepsia.  Chronically  impaired  appetite.  Gastric 
disturbances. 

1.  Simple  chronic  dyspepsia.  Appetite  for  con- 
centrated  food    (grain)    impaired,   otherwise    normal. 

2.  Acid  dyspepsia.  Impaired  appetite,  but  a  craving 
for  alkalies;  licking  whitewashed  walls,  nibbling  at  soiled  litter. 

3.  Nervous  dyspepsia.  This  occurs  in  easily  excitable 
horses  and  consists  in  temporary  disturbances  of  appetite  after 
excitement. 

Chronic  gastro-intestinal  catarrh.  Gastro-enteritis  catarrhalis- 
chronica.     Soft  consistency  of  feces,  or  hard  and  soft  alternately,. 


DIGESTIVE    APPARATUS.  165 

■containing  mucus,   appetite   impaired.      Mucous   membranes   muddy 
red.      Urine   acid. 

Colic  of  horses.  The  term  colic  is  applied  in  a  general  way 
to  pathological  conditions  of  the  gastro-intestinal  tract  that  cause 
horses  to  manifest  symptoms  of  pain.  As  a  rule  they  are  caused 
by  interrupted  progress  of  the  intestinal  contents.  The  most  im- 
portant symptoms  are  those  indicating  pain,  efiforts  to  uri- 
nate and  defecate,  diminished  peristalsis  and  retarded  defeca- 
tion. Sometimes  impaction  or  torsion  of  the  bowels  can  be  rec- 
ognized as  the  causes  (rectal  examination).  Before  making  a 
prognosis  note  carefully  the  condition  of  the  conjunctiva  and  the 
pulse. 

Gastro-enteritis.  Inflammation  of  the  stomach 
and  intestine.  High  fever,  great  depression  of  the  sensorium, 
mucous  membranes  muddy  red;  pulse  very  rapid,  respiration  in- 
creased. Complete  loss  of  appetite,  buccq.1  mucous  membrane  hot, 
feces  as  m  diarrhea,  foul  odor,  and  bloody.  Rising  is  painful! 
Forms:  Gastro-enteritis  rheumatica,  toxica,  cruposa,  mycotica 
parasitica.  ' 

c.     Gastric  and   Intestinal   Diseases   of  Cattle. 

_  Acute  tympanitis.  Hoven,  bloat.  Rapid  tympanitic  disten- 
tion of  the  paunch,  food  and  drink  are  refused,  defecation  retard- 
ed. Increased  and  labored  breathing,  animals  are  anxious  and 
restless. 

Acute  dyspepsia.  Acute  derangement  of  activity  of  stomach. 
No  fever.  Feed  is  absolutely  refused,  rumination  suspended,  belch- 
ing, abdomen  full,  paunch  contents  firm,  paunch  movements  slight, 
auscultation  reveals  sounds  of  bursting  bubbles,  feces  dry,  later  on 
containing  coarse   food   particles. 

Acute  gastro-intestinal  catarrh.  Fever,  conjunctiva  reddened, 
pulse  frequent,  appetite  often  entirely  wanting,  flanks  sunk  in, 
paunch  movements  incomplete.      Milk  secretion  suddenly  retarded. 

Chronic  gastro-intestinal  catarrh.  Gradual  development  and 
frequent  change  of  symptoms.  Appetite  reduced,  bloating  follows 
a  heavy  feed,  rumination  interrupted.  Defecation  usually  retard- 
ed, feces  mixed  with  mucus,  now  and  then,  diarrhea.  If  disease 
is   severe   diarrhea   is   continuous.     Animal   weak,   falls   off  in   flesh. 

Chronic  tympanitis,  chronic  indigestion.  Periodi- 
cally recurring  attacks  oi  slight  bloating  of  paunch  that  continue 
for  some  time.  Rumination  and  paunch  movements  retarded. 
Coarse   food   particles   in   feces. 

Dislocation  of  bcwel.  1.  Invagination  (telescoping)  of 
infesting.  Occurs  suddenly  and  without  external  cause.  Animals 
are  restless,  lie  down,  get  up  again,  kick  their  bellies,  groan.  These 
symptoms  attended  with  fever.  Feeding  and  rumination  cease, 
obstinate  constipation,  discharges  of  mucus  and  blood.  Pains 
soon  grow  less  but  fever  increases.  Palpation  per  rectum  usually 
enables  us   to   feel   the   invaginatcd  gut. 

2.  P  e  r  i  to  n  c  a  1  _  h  e  r  n  i  a  or  gut  tie  in  the  ox.  Symp- 
toms same  as  in  invagination,  in  addition  an  abducted  position  of 


166  CLINICAL    DIAGNOSTICS. 

hind  leg  which  is  also  extended  back.  Sacral  region  depressed. 
Palpation  per  rectum  reveals  presence,  at  anterior  border  of  ileum, 
of  painful  doughy  swelling,  held  in  place  by  vestige  of  spermatic 
cord. 

Licking  disease  of  cattle  and  wool  eating  of  sheep  are  pecu- 
liar chronic  affections;  afflicted  animals  have  a  habit  of  licking, 
nibbling,  or  even  swallowing  objects  of  a  various  nature,  including 
indigestible  and  often  loathsome  and  disgusting  substances.  At 
the  same  time  there  is  loss  of  appetite  and  emaciation. 

d.     G  a  s  t  r  o  -  I  n  t  c  s  t  i  n  a  1      Diseases   of  the   Dog. 

Acute  Gastric  Catarrh.  Frequently  febrile.  Usually  begins 
with  vomiting  of  food  masses,  followed  by  vomiting  of  mucus. 
Loss  of  appetite,  increased  thirst,  depression,  evacuation  of  bow- 
els retarded,  sj-mptoms  of  pain  upon  pressure  over  the  region  of 
the    stomach. 

Acute  Intestinal  Catarrh.  Usually  febrile  and  attended  with 
diarrhea;  feces  of  bad  odor  and  frequently  fermenting.  Icterus 
and   bile    pigments   in   urine   common    symptoms. 

Constipation.  Cause,  as  a  rule,  in  the  rectum.  Defecation 
retarded,  animals  make  frequent  unsuccessful  attempts,  tail 
elevated.  Abdomen  frequently  bloated;  palpation  reveals  impac- 
tion of  rectum,  painful  upon  pressure.  Digital  exploration  reveal- 
ing  presence   of   hard   fecal   masses. 

Foreign  Bodies  in  the  Intestines.  Frequently  situated  anterior 
to  the  ileo-cecal  valve.  Vomiting,  complete  loss  of  appetite,  ab- 
sence of  fever.  Object  can  usuallj-  be  located  bj^  carefiil  palpation 
of  pelvic  region.  Caution:  Do  not  confuse  with  kidneys,  especially 
in    cat. 

e.     Diseases     of     the     Peritoneum. 

Acute  Peritonitis.  L^sually  secondary,  following  rupture  or 
perforation  of  intestine,  perforation  of  abscesses  or  extension  of 
inflammation  of  adjacent  organs;  symptoms  therefore  not  charac- 
teristic. Symptoms  of  colic,  stiff  gait,  looking  at  the  flank,  groan- 
ing. Marked  depression,  staring^  look,  moderate  to  high  fever.  Mu- 
cous membranes  reddened.  Pulse,  rapid,  small,  soft.  Respiration 
short,  superficial,  frequent.  No  appetite  for  food  or  water,  ab- 
dominal muscles  contracted,  painful;  peristalsis  suspended,  some- 
times diarrhea  as  death  approaches.  Defecation  and  urination 
retarded,  painful.     Death  often  following  after  a  few  hours. 

Chronic  Peritonitis.  In  horses,  SA-mptoms  of  colic  and  fever, 
irregular  appetite  and  emaciation.  In  cattle  and  dogs  colic  symp- 
toms absent,  but   pain  upon  palpation,  presence  of  exudates. 

Traumatic  Inflammation  of  Stomach  and  Diaphragm  in  Cattle. 
Indigestion  of  sudden  appearance  without  apparent  cause.  Ani- 
mals show  disinclination  to  lie  down,  stand  in  stiff  position,  are 
very  careful  when  rising  and  don't  stretch.  Expression  of  eyes 
indicating  pain.      Surface  temperature  irregularly  distributed,  bod- 


URINARY    APPARATUS.  167 

ily  temperature  elevated.  Pulse  accelerated  and  hard.  Respira- 
tion rather  retarded,  groaning  and  manifestations  of  pain.  No 
appetite  for  food  or  drink,  rumination  suspended.  Pressure  on  the 
right  side,  sixth  and  seventh  ribs,  painful.  Milk  secretion  de- 
creased. 

f .     Infectious     Diseases     with     Localization 
in     the     Digestive     Tract. 

Rinderpest  is  a  readily  transmissible,  acute  infectious  disease, 
of  cattle.  It  usually  takes  a  fatal  course.  Period  of  incubation 
6-7  days.  High  temperature  is  the  first  symptom.  Eyelids  swol- 
len, conjunctiva  very  red,  respiration  difficult,  dirty  yellowish  nasal 
discharge,  nasal  mucous  membrane  reddened  in  spots,  cough, 
moist  rales,  frequently  interstitial  pulmonary  emphysema  and  cu- 
taneous emphysema;  complete  loss  of  appetite,  feces  fluid,  discol- 
ored; secretion  of  milk  suspended,  great  depression,  and  general 
weakness  of  the  body.  Dark  red  areas  on  mucous  membranes 
which  (spots)  become  coated  with  grayish  white  layers,  when  the 
latter  drop  off  and  leave  ulcerous  erosions.  [Most  animals  die  on 
the  fifth  or  sixth  da}'. 

Stomatitis  pustolosa  contagiosa  is  an  exanthema  with  a  t3'pical 
course.  It  occurs  in  the  form  of  pustules,  principally  at  the 
mouth,  and  is  characterized  by  its  mild  course.  Period  of  incu- 
bation 3-5  days.  At  first  appearance  of  eruption  there  is  fever, 
but  this  soon  subsides.  Horses  refuse  feed,  they  salivate,  mouth 
painful  to  the  touch.  Within  2-3  days  minute  nodules  or  blisters 
appear  on  the  mucous  membrane;  these  are  at  first  red.  then  gray 
or  yellow,  break  open  and  form  ulcers.  Intermaxillary  glands 
swollen,  conjunctivitis,  now  and  then  ulcers  on  the  outer  part 
(skin)  of  the  lips,  forearm  and  body;  healing  requires  10  days  to 
two   weeks. 

g.     Intoxications. 

Lupinosis  is  an  intoxication  disease  affecting  tlie  body  as  a 
whole.  It  is  caused  by  a  poisonous  principle  (lupinotoxin)  which 
occurs  in  lupines.  Diminished  appetite,  increased  temperature, 
icteric  coloration  of  conjunctiva,  general  weakness,  cerebral  de- 
pression.     Urine   yellow,  contains   bile  pigments   and  albumin. 

[Loco  weed  poisoning.*  An  intoxication  disease  afifecting 
chiefly  the  nervous  system.  Effects  not  noticeable  until  a  consid- 
erable quantity  of  the  "loco  weed"  has  been  eaten.  Gait  slow  and 
measured,  eyes  glassy  and  staring,  vision  interfered  with,  convul- 
tions  when  animal  is  excited,  later  on,  general  emaciation.  Occurs 
in   western    States.] 

IX.     Urinary  Apparatus. 

In  diagnosing-  diseases  of  the  lungs  perctission  and  aus- 
cultation of  the  chest  is  of  fundamental  importance.  In  dis- 
eases of  the  urinary  apparatus  we  depend  on  the  results  of 

*  U.  S.  Report. 


168  CLINICAL    DIAGNOSTICS. 

physical  and  chemical  examinations  of  the  urine.  Experience 
has  taught  us  that  affections  of  the  kidneys  and  urinary  tract 
are  not  as  common  in  animals  as  they  are  in  man  and  conse- 
quently urinary  analyses  hardly  merit  the  same  importance 
that  is  attached  to  them  by  physicians.  Besides  this  the  entire 
field  of  kidney  pathology  in  animals  has  received  so  little  at- 
tention from  investigators  that  our  lack  of  knowledge  is  often 
evident  to  the  diagnostician. 

Results  of  a  urine  examination  often  enable  us  to  diag- 
nose affections  of  other  organs  the  abnormal  products  of 
which  pass  over  into  the  urine. 

The  collection  of  the  urine  from  animals  is 
always  attended  with  difficulties,  in  practice  it  is  often  impos- 
sible. As  a  rule  the  urine  is  caught  up  in  a  vessel  during  the 
natural  act  of  the  animal.  In  horses  a  vessel  can  be  secured 
to  the  sheath  and  the  urine  thus  collected.  In  female  animals 
the  use  of  a  disinfected   catheter  is  permissible. 

In  the  course  of  the  clinical  examination  we  consider  the 
urine  first  ;  if  the  latter  shows  material  changes  we  also 
examine   the  urinary  organs. 

Accordingly  we  consider  the  following  points  and  in  the 
order  given : 

I.     Manner    of    Voiding    the    Urine. 

II.     Examination   of   the   Urine. 
/  A.     Macroscopical  examination. 

B.  Chemical   examination. 

C.  ]\Iicroscoi)ical  examination. 

III.     Examination   of  t  h  e '  U  r  i  n  a  r  y   Organs. 

I.    Manner  of  Voiding  the  Urine. 

In  our  domestic  animals  urinating  is  a  reflex  act  inaugurated 
by  the  stimulus  of  the  urine  on  the  mucous  membrane  of  the  dis- 
tended bladder.  As  long  as  the^distention  of  the  bladder  is  below  a 
certain  point  the  reflex  action  of  the  sphincter  vesicae  which  is 
also  inaugurated  by  the  pressure  of  the  urine,  supersedes  that  of 
the  muscular  coat,  hence  the  one  gives  way  to,  or  takes  the  place 
of,   the   other   as  occasion   demands. 


URINARY    APPARATUS.  169 

In    adult     male      dogs  only   do    we    observe    frequent    and 

-voluntary  urina  ion.      For   this  act   they  prefer  places   used   for   the 

same   purpose   by   other   dogs.  Their   choice   places   are   trees    the 

corners   of   '-  —  '---     -^-^  ^                     i-iccs,    mc 


ises.   etc. 


When  urme  is  voided  the  bladder  contracts  and  this  is  aided 
by  the  abdominal  muscles.  Every  species  of  animal  manifests 
peculiarities  of  its  own  m  this  act,  but  it  is  a  rule  that  all  animals 
stand   while   urinating. 

Horses  (both  sexes)  urinate  only  while  resting  and  cease  feed- 
ing tor   the  time;   not  infrequently   they  emit  loud  groans. 

Cows    urinate    similarly    to    mares,    male    cattle    on    the    other 
hand   urinate    not    only   while    feeding   but    also    while    walkijig-    in 
tact,  in  these  animals  the  act  seems  almost  to  be  a  passive  one 
_        Old    dogs    and    pigs    (male)    void    the   urine    in    an    interrunted 
lerky    stream.  ^ 

a.  The  frequency  of  urination  depends  on  the  amount  of 
water  imbibed,  the  amount  of  water  lost  by  respiration,  perspira- 
tion, and  per  intest  nal  tract;  accordingly  it  varies  very  consider- 
ably.      Healthy   horses      ordinarily      urinate    5-G    times    a    day. 

1.  Abnormal  frequency  of  urination  occurs  during  in- 
creased secretion  of  urine  (polyuria)  in  the  course  of  dia- 
betes, and  in  chronic  inflammation  of  the  kidneys,  temporarily 
in  the  crisis  of  severe  diseases  (contagious  pleuro-pneumonia 
of  horse). 

2.  Urination  is  suppressed,  when  rupture  of 
the  bladder  has  occurred  (urethral  calculus)  in  oxen;  to 
determine  (in  doubtful  cases)  whether  or  not  an  ox  urinates 
a  clean  cloth  is  tied  in  front  of  the  opening  of  the  urethra. 

b.  Abnormally  frequent  attempts  to  urinate,  only 
slight  quantities  of  urine  being  passed  at  each  attempt, 
stranguria.  The  cause  of  this  is  an  abnormal  irritability  of 
the  mucous  membrane  of  the  bladder  and  urethra.  Such 
conditions  are  most  frequently  observed  in  the  course  of 
colic  in  horses  where  the  distended  intestines  (impaction,  con- 
stipation, tympanitis)  exert  a  pressure  on  the  bladder,  or  the 
sense  of  fulness  of  the  abdomen  causes  the  animals  to  make 
these  attempts.  Inflammatory  conditions  of  the  bladder 
(bladder  diseases,  stone  and  gravel,  neoformations,  poison- 
ing with  irritating  substances)  or  of  the  urethra  (applica- 
tions of  pepper)    are  much  le.ss  common  causes.      Mares  in 


ITO  CLIXICAL    DIAGNOSTICS. 

oestrum   often    show   these    symptoms   at   the    same   time   re- 
peatedly  protruding   the   cHtoris. 

c.  When  urination  is  painful  the  term  dysuria  is  ap- 
plied. The  animals  are  restless,,  step  to  and  fro,  kick  at 
their  bellies,  switch  their  tails,  look  back  af  the  abdomen, 
groan,  and  void  urine  in  drops  or  thin  streams.  The  seat 
of  the  pain  may  be  in  the  bladder  or  in  the  urethra  (concre- 
ments,  strictures,  inflammations).  Sometimes  the  pain  is 
caused  by  abdominal  pressure  in  peritonitis. 

d.  Retention  of  urine  (ischury)  is  attended  with  accu- 
mulation of  urine  in  the  bladder.     It  is  observed: 

1.  In  obstruction  of  the  urethra  (concre- 
ments,  swellings,  strictures,  tumors").  In  such  cases  the  urine 
is  voided  in  drops  or  thin  streams,  and  frequently  with  symp- 
toms  of   pain. 

2.  In  p  a  r  a  1  }•  s  i  s  of  the  bladder;  frequently 
associated  with  paralysis  of  the  rectum  and  of  the  tail. 

e.  Inability  to  retain  urine, /7/fo/z////r;;/m  urinac,  occurs 
as  a  result  of  paralysis  or  weakening  of  the  sphincter  of  the 
bladder,  or  as  a  result  of  diminished  sensitiveness  of  the 
urethral  mucous  membrane,  thus  suspending  the  reflex  ex- 
citability of  the  sphincter.  Most  frequently  observed  in  dogs 
in  the  course  of  distemper  (spinal  affection)  but  otherwise 
rare  in  animals. 

11.     Examination  of  the  Urine. 

A.     Macroscopical    Examination. 

a.  The  quantity  of  urine  voided  depends  on  the  same 
conditions  that  regulate  the  frequency  of  voiding  it :  on  the 
average  horses  secrete  4:-5  liters,  cattle  C-12  and  dogs  Y^-l 
liter  per  day.  As  a  rule  we  determine  the  quantity  of  urine 
voided  daily  by  making  an  estimate.  Collecting  the  urine  for 
actual  measurement  is  cumbersome  and.  besides,  not  exact. 

A  decrease  in  the  quantity  of  urine  is  observed  in : 

Profuse   sweating  and  diarrhea. 


URINARY    APPAR.\TUS.  171 

Severe   febrile   diseases. 

Formation  of  large  quantities  of  exudates  in  the  pleural 
and  peritoneal  cavities. 

Weak  heart  and  resulting  diminished  pressure. 

Acute  and  some  forms  of  chronic  nephritis. 

An  increase  in  the  quantity  of  urine  occurs  in: 

Diabetes  insipidus  [polyuria]  (very  marked)  diabetes 
mellitus   (which  is  rare),  the  daily  average  may  be  40  liters. 

Most  forms  of  chronic  nephritis. 

During  reabsoption  of  profuse  exudates  and  in  the  criti- 
cal stage  of  severe  infectious  diseases. 

b.  The  color.  The  normal  pigments  in  urine  have  not 
yet  been  thoroughly  studied ;  although  a  number  of  them 
are  known  to  exist,  only  one  has  been  identified,  viz.  urobilin 
which  is  a  product  of  bilirubin  and  is  absorbed  from  the 
intestine.  The  color  of  normal  urine  is  more  or  less  yellow, 
increasing  in  darkness  as  the  amount  of  urine  decreases,  and 
vice  versa.  In  disease  the  color  may  become  lighter  or 
darker.  We  distinguish:  yellow  (pale  yellow,  light  yellow, 
yellow),  red  (reddish  yellow,  yellowish  red;  red),  and  brown 
(brownish  red,  reddish  brown,  and  blackish  brown)  urine. 
Other  shades  can  also  be  recognized  now  and  then. 

Pale,  water-colored  urine  always  occurs  in  polyuria 
(physiological  or  critical  polyuria,  diabetes). 

Red  urine  is  produced  by  admixture  of  blood,  hemaglo- 
bin  or  methemaglobin.  The  particular  cause  in  each  case 
must  be  determined  with  the  aid  of  the  microscope. 

Greenish  yellozv  or  brozvnish  yellozv  urine  or  yellowish 
green   foam   is  produced  by  bile-pigments. 

Dark  eolored  urine  (dark  yellow  or  dark  brown)  is  ob- 
served in  all  cases  where  the  quantity  has  been  reduced  (con- 
centrated), but  it  may  also  be  due  to  admixture  of  blood. 

Color  due  to  medicines:  carbolic  acid,  black;  aloes  and 
rhubarb,   brownish    red. 

c.  Transparency  of  urine.     Normal  urine  of  the  horse 


172 


CLIXICAL    DIAGNOSTICS. 


is  always  turbid;  even  tlie  first  few  droi)s  voided:  toward 
the  end  it  becomes  even  more  so,  frequently  a  li.^ht  clay 
color.  The  turbidity  is  due  to  the  presence'  of  ciirbonates 
which  precipitate  in  the  bladder  as  the  fluid  becomes  more 
or  less  condensed  from  reabsorption  processes.  \Mien  ex- 
posed to  the  air  in  a  vessel  the  turbidity  increases  because 
the  soluble  acid  calcium  carbonate  (CO3H),  Ca  after  giving 
off  CO,  H,0  is  converted  into  insoluble  calcium  carbonate 
CO3  Ca.  This  conversion  occurs  most  rapidlv  at  the  surface 
of  the  liquid,  causing  the  formation  of  a  tlnn  fragile  mem- 
brane at  that  place  (crystals  of  calcium  carbonated  Small 
granules  of  lime  also  precipitate  and  constitute  a  part  of  the 
sediment.  Not  infrequently  these  lime  granules  are  im- 
bedded in  cylindrical  masses  of  mucus  that  were  molded  in 
the  uriniferous  tubules.  This  normal  turbid  urine  has  an 
alkaline  reaction. 

Clear  urine  of  the  h  o  r  s  e  is  always  abnormal 
and  usually  has  an  acid  reaction  ;  upon  cooling.'  however,  it 
may  become  turbid.  The  turbidities  consist  of  precipitated 
phosphates,  oxalate  of  lime,  and  crystals  of  gvpsum  and  uric 
acid  salts ;  these  dissolve  upon  heating  the  fluid.  These  salts 
can  be  recognized  by  means  of  a  microscopical  examination. 

A  b  n  o  r  m  a  1  t  u  r  b  i  d  i  t  y  may  be  due  to  the  presence 
of  organized  elements  (cells)  ;  recognized  by  means  of  mic- 
roscopical   examination. 

In  the  ox,  sheep  and  goat  the  normal  urine  is 
clear  when  voided  but  becomes  turbid  on  standing:  precipita- 
tion  of  monocarbonates. 

The  urine  of  the  dog  is  clear  in  health,  becom- 
ing slightly  turbid  after  standing:  due  to  precipitation  of 
uric  acid  salts. 

d.  Consistency  of  urine.  Normal  urine  of  the  horse 
is  a  rather  thickish.  slimy,  viscous  fluid;  the  viscositv  being 
due  to  an  admixture  of  mucine  which  occurs  in  the  bladder. 
Besides  this  the  cast  off  epithelial  cells   undergo  a   process 


URINARY    APPARATUS.  173 

of  swelling  and  thus  increase  the  consistency  of  the  urine. 
Acid  horse  urine  is  always  less  viscid  than  such  as  gives 
an  alkaline  reaction  because  the  epithelial  cells  swell  more 
in  the  former. 

All  other  domestic  animals  excrete  a  more  watery  urine. 

e.  The  specific  gravity  of  urine  is  determined  with  an 
araeometer,  also  called  u  r  i  n  o  m  e  t  e  r  when  specially  con- 
structed for  this  specific  purpose. 

The   specific  gravity   for  the 

horse  is  1020—1050,  average  1040, 
ox        "  1025—1045,  "       1030, 

dog     "  1020—1060,  "       1040. 

The  specific  gravity  varies  inversely  with  the  quantity. 
Aside  from  this  an  a  b  n  o  r  m  a  11  >•  1  o  w  specific  gravity  is 
observed  in  diabetes  insipidus  (1001-1010)  and  in  contracted 
kidney. 

An  a  b  n  o  r  m  a  1 1  y  high  specific  gravity  is  observed  in 
all  cases  where  the  amount  of  urine  secreted  is  below  the 
normal  (fever)  and  in  acute  nephritis.  High  specific 
gravity  and  increased  quantity  is  observed 
only  in  diabetes  mellitus. 

B.     Chemical    Examination    of    the    Urine. 

a.  The  reaction  of  the  urine  of  healthy  animals  de- 
pends on  the  kind  of  food:  herbivora  (horse,  ox,  sheep,  goat) 
secrete  an  alkaline  urine,  carnivora  (dog.  cat)  secrete  acid 
urine.  In  omnivora  the  reaction  depends  altogether  on  the 
food. 

In  herbivora  the  alkaline  reaction  is  due  to  the 
presence  of  acid  bicarbonate  of  lime  CO3H  —  Ca  —  CO3H. 
The  organic  acid  salts  of  lime  which  are  contained  in  the  food 
contain  the  acid  radicles  of  malic,  tartaric,  succinic  and  lactic 
acids.  These  latter,  upon  being  absorbed  into  the  blood,  be- 
come oxydized  into  acid  carbonates  which  have  an  alkaline 
reaction. 

In    carnivora    acid   phosphates     are    the     cause     of    the 


174  CLINICAL    DIAGXOSTICS. 

acid  reaction;  POJI.Xa  and  PO^H.Ca;  thesa  come  from 
the  animal  diet.  Starving  herbivora  (hence  such  as  Hve  on 
their  own  flesh)    have  an  acid   urine. 

Except  in  cases  like  the  one  just  mentioned  an  acid  reac- 
tion of  the  urine  of  herbivora  is  always  abnormal.  It  occurs 
when  the  contents  of  the  small  intestine  have  an  acid  reaction 
— intestinal  catarrh.  When  the  contents  of  the^  small  intes- 
tine have  a  normal  (alkaline)  reaction  the  acid  phosphates 
in  the  food  are  not  absorbed,  and  consequently  do  not  enter 
the  circulation,  but  when  the  reaction  is  acid  the  opposite 
takes  place,  the  acid  phosphates  are  absorbed  and  excreted 
by  the  kidneys,  but  the  organic  acid  salts  are  not  absorbed. 
An  acid  reaction,  therefore,  depends  on  the  presence  of  acid 
phosphates  and,  in  case  of  herbivora  with  good  appetite, 
points  to  the  existence  of  intestinal  catarrh. 

Abnormal  alkaline  reaction  of  the  urine  of 
herbivora  and  carnivora  occurs  in  the  course  of  fermenta- 
tions in  the  bladder  (catarrh)  and  is  produced  by  ammonia, 
which  is  a  product  of  fermented  urea:  CO(XH.')o  + 
2H,0  =  CO3  (NHJo  =  2NH3  +  CO,  +  H,0. 
This  ammoniacal  fermentation  can  be  recognized  by  its  od  ^r. 
A  glass  rod  dipped  in  hydrochloric  acid  and  held  ai:ove 
the  surface  of  the  urine  causes  fumes  to  appear :  NH^Cl 
=   ammonium   chloride. 

b.  Albumin.  Serumalbumin  associated  with  serum- 
globulin  is  the  usual  form  in  which  albumen  occurs  in  urine. 
Albumoses,  i.  e.,  albuminous  bodies  not  precipitated  by  boil- 
ing, may  be  found  alone  or  in  connection  with  the  above,  but 
are  of  rarer  occurrence.  (Pepton,  propepton,  hemialbumose). 
Occasionally  hemoglobin  and  methemoglobin  are  found. 

These  three  groups  are  alone  of  practical  importance. 

I.  Albuminuria.  Albumin  never  appears  in  normal 
urine  in  appreciable  quantity ;  its  presence  must  therefore 
always  be  looked  upon  as  an  indication  of  disease. 

As  a  rule  the  albumin  is  secreted  with  the  urine,  in  the 


URINARY    APPARATUS.  175 

kidneys  (renal  albuminuria),  in  rare  cases  jjs  presence  is 
due  to  admixture  of  blood  or  pathological  products  (acci- 
dental albuminuria). 

The  fact  that  healthy  urine  contains  no  albumin  in  ap- 
preciable amount  is  explained  by  the  impermeability  of  the 
renal  epithelium  to  albumin  and  by  the  limited  normal  blood 
pressure.  A  change  from  the  normal,  such  as  may  be 
brought  about  by  pathological  conditions  of  the  blood  or  in- 
creased bodily  temperature,  may  cause  the  appearance  of 
albumin  in  the  urine. 

Hence,   renal  albuminuria   can  occur : 

1.  As  a  result  of  changes  in  the  renal  tis- 
sues due  to  inflammatory  or  degeneration  processes ;  here 
we  find  not  only  albumin  present,  but  the  quantity  of  urine 
may  be  increased  by  the  addition  of  albuminous  exudate. 

2.  In  lowering  of  arterial  pressure;  the 
lower  the  pressure  the  easier  can  a  diffusion  of  albuminous 
substances  take  place.  Pressure  is  lowered  in  weak  heart  or 
in  venous  congestion  (organic  heart  disease,  emphysema). 
Both  conditions,  after  existing  for  some  time,  in  addition 
produce  changes  in  the  renal  epithelium. 

3.  I  n  f  e  V  e  r  albuminuria  is  always  present.  Several 
factors  are  active  here.  The  lowered  pressure  may  alone 
account  for  it;  the  elevated  temperature  facilitates  the  pro- 
cess ;  continued  fever  produces  changes  in.  the  renal  epithe- 
lium. In  case  of  severe  infectious  fevers  a  direct  injury  to 
the  renal  parenchyma  probably  occurs  because  in  such  cases 
the  urine  is  very  rich  in  albumin. 

4.  Mere  changes  in  the  normal  composi- 
tion of  the  blood,  in  the  absence  of  any  change  of 
blood  pressure  or  change  of  structure  of  the  kidneys,  may 
bring  about  albuminuria  (leucemia). 

From  what  has  been  stated  we  can  readily 
see    that    the    mere    presence    of    albuminuria 


176 


CLINICAL    DIAGNOSTICS. 


does  not  necessarily  indicate  an  affection  of  the 
kidneys. 

Accidental  albuminuria  is  rare  and 
of  little  importance.  We  assiiiiic  that  the  albu- 
minuria is  accidental  when  the  filtrate  contains 
large  (luantities  of  blood  and  pus  corpuscles  and 
epithelial  cells  and  only  a  moderate  quantity  of 
albumin.  In  that  case  the  proportionately  small 
amount  of  albumin  is  supposed  to  result  from  par- 
tial solution  of  the  cellular  elements. 

Chemical  determination  of  albuminuria.  For 
this  use  freshly  voided  urine ;  if  not  clear,  filter. 

1.  Koch's  test.  Fill  test  tube  to  yi  its  height 
with  urine — if  alkaline  add  a  drop  of  acetic  acid — boil 
and  then  g,dd  1-10  its  volume  of  dilute  nitric  acid  (sp. 
gr.  1.18);  a  permanent  precipitate  indicates  albumin. 
if  a  precipitate  or  turbidity  produced  by  boiling  dis- 
appears on  addition  of  nitric  acid  it  indicates  phosphate 
of  lime. 

2.  Heller's  test.  The  cold,  filtered  (and,  if 
necessary,  acidulated)  urine  is  carefully  poured  on  con- 
centrated nitric  acid,  so  as  to  form  a  layer  on  the  same. 
If  albumin  is  present  a  white  or  cloudy  ring  is  formed 
in  the  test  tube  where  the  urine  comes  in  contact  with 

Ksba  hs      i\jQ  nitric  acid. 
Albummi-  . 

meter.  3.     Acetic         acid       fcrro-cyanide       of 

potash  test.  To  the  filtered  urine  add  a  quan- 
tity of  acetic  acid  and  then  a  few  drops  of  a  5%  solu- 
tion of  potassium  ferrocyanide;  the  presence  of  albumin  produces 
a  white  precipitate. 

If  the  addition  of  acetic  acid  produces  cloudiness  mucin  is 
present;  in  this  case  filter  the  urine.  The  mucin  may  also  be  pre- 
cipitated  with'  acetate    of   lead    before   making   the    test. 

4.  In  case  only  a  limited  quantity  of  urine  is  obtainable,  the 
following  method  is  recommended:  Heat  distilled  water  to  boil- 
ing point  in  a  test  tube,  add  the  urine  drop  by  drop.  If  albumin 
is  present  the  drops  become  turbid  in  the  water,  and  by 
continuing  the  addition  of  the  urine,,  the  water  also  becomes 
turbid. 

The  methods  here  given  suffice  for  the  clinical  demonstration 
of  albumin.  For  a  quantitative  determination  of  the  albumin 
preserve  the  tubes  containing  the  precipitate  and  thus  the  sedi- 
ment, which  consists  of  albumin,  may  be  compared  from  day  to 
day.  For  this  purpose  Esbach's  albuminimeter  is  both  simple 
and    practical.      See    fig.    40.       [Similar    tubes    can    be    obtained    in 


URINARY    APPARATUS.  177" 

the  United  States.]  It  is  used  as  follows:  Fill  the  tube  with 
urine  to  the  mark  U  (urine),  then  add  reagents  sufficient  to  fill 
the  tube  up  to  the  mark  R  (reagents)  as  follows:    '""''''^"^   ^°  ^"^^ 

citric  acid,  2.0  cc, 

picro-nitric    acid    1.0    cc, 

distilled  water  100.0  cc; 
put  on  a  stopper,  shake  well,  and  let  stand  24  hours.     The  sedi- 
nr^Tn^'"^'    t7'''-'  °^  albumin   can  then   be  read  off  in  fractions 
^rnm,"n?  nf      ll       •  "''^^^""^^"t    gives    good    results    providing    the 
amount   of   albumin   present   does   not   much   exceed   0.2%;   in   that 

one  or  t'lr..  °l'  '''''"f  '^'  """'•  '""'^  ^°  ^'^^^  °^  ^.5%.  bv  adding 
hrm^iU  nl'!^  volumes  of  water  respectively;  the  result  must  theS 
be  multiphed  by  2  or  4  according  to  the  dilution. 

Albuminuria    occurs : 

In  all  febrile  diseases,  especially  in  acute  infectious  dis- 
eases; contagious  pleuro-pneumonia  of  the  horse  and  in  in- 
fluenza. 

In  acute  and  chronic  affections  of  the  kidneys. 

In  venous  congestion,  hence  in  organic  heart  disease, 
emphysema  and  in  the  various  forms  of  heaves 

In  blood   diseases;  leukaemia,   ansemia. 

In  nervous   affections,   epilepsy,   eclampsia. 

II.  Albumosuria.  Examinations  for  albumoses  have 
only  recently  become  of  importance,  since  simpler  methods 
have  been  discovered.  The  occurrence  of  albumoses  de- 
pends upon  entirely  different  conditions  than  those  which 
produce  albuminuria.  Albumosuria  is  not  caused  by  in- 
flammation of  the  kidneys,  by  disorders  of  circulation  nor  by 
anemia.  Changes  in  the  composition  of  the  blood  play 
the  chief  role  here.  Albumoses  cannot  be  determined  by 
boiling  the  fluid  containing  them,  nor  by  the  addition  of" 
acids.  It  is  only  in  the  absence  of  other  albuminou's  sub- 
stances (albumin,  globulin,  mucin)  and  various  other  pig-- 
ments  that  their  presence  can  be  determined. 

Chemical  determination  of  albumoses.  Take  10  cc  of  unfil- 
tered  urine  and  acidulate  with  a  207c  solution  of  acetic  acid.  If^ 
the  reaction  of  the  urine  is  acid,  two  or  three  drops  will  suffice, 
if  alkaline,  l^  requires  more.  Add  5cc  of  a  20%  solution  of  ace- 
tate of  lead,  boil  and  filter.  Add  to  the  filtrate  a  solution  of  caus- 
tic potash  until  precipitates  no  longer  occur;  it  may  require  15ce 
or  more  of  the  potash  solution  to  bring  about  this,  result ^  it  is  im^- 


178  CLINICAL    DIAGNOSTICS. 

portant  to  use  sufficient  potash  solution  as  otherwise  the  reaction 
will  not  occur.  The  filtrate  is  now  subjected  to  the  biuret  reac- 
tion: Add  five  or  six  drops  of  a  solution  of  sodium  hydrate,  then 
add,  carefully,  one  or  two,  or  at  the  most,  three,  drops  of  a  10% 
solution  of  sulpliate  of  copper.  If  albumoses  are  present  a  red- 
dish violet  color  is  produced.  This  test  is  the  simplest  and  most 
reliable  for  testing  the  urine  of  animals,  since  all  substances  that 
might  otherwise  have  interfered  with  the  test  are  removed. 

Schulz's  method  is  very  simple  and  reliable.  Filter  the 
urine  and  add  several  volumnes  of  alcohol  to  precipitate  all  of 
the  albuminous  substances.  Filter  again  and  treat  the  residue 
(precipitate)  with  a  stream  of  water;  this  dissolves  the  albumo- 
ses, if  present,  and  then  the  biuret-reaction  is  applied  to  this  solu- 
tion. 

Albumoses  occur  in  the  urine  in  the  course  of  abscess 
formation  in  the  internal  organs  of  the  body  (Strangles),  and 
as  a  result  of  the  absorption  of  extensive  exudates  in  the  course 
of  influenza  of  horses,  peritonitis  and  pleuritis. 

The  determination  of  albumoses  is  of  clinical  importance 
for  the  determination  of  suspected  abscess  formation  in  inter- 
nal organs. 

III.  Hemaglobinuria.  The  fact  that  urine  con- 
tains blood  may  often  be  recognized  by  its  color  alone ;  light 
red  urine,  resembling  meat  water,  (oxyhemoglobin)  is  rare. 
As  a  rule  it  has  a  muddy  brownish  red  color  (methemo- 
globin).  A  diagnosis  cannot  be  based  upon  the  color  alone, 
a  chemical  and  microscopical   examination  is   necessary. 

Chemical  determination.  Add  caustic  potash  or  soda  until 
the  urine  is  distinctly  alkaline,  then  boil  as  in  albumin  test.  This 
converts  the  hemoglobin  into  hematin,  it  is  precipitated  with  the 
•earthy   salts   and   gives   them  a   reddish   brown   color. 

The  difiference  between  oxyhemoglobin  and  methemoglobin 
must  be  determined  with  the  spectroscope.  Oxyhemoglobin  gives 
two  absorption  bands  between  D  and  E,  methemoglobin  gives 
vne  between   C  and  D. 

The  presence  of  hemoglobin  may  be  due  to  admixture 
of  blood  as  such  (hematuria)  or  to  hemoglobin  alone  (hemo- 
globinuria). 

Hematuria  is  recognized  by  microscopic  examination 
of  the  sediment  and  the  detection  of  blood  corpuscles.  The 
admixture  of  blood  can  occur  in  the  kidney,  the  pelvis  of 
the  kidnev,  the  bladder  or  the  urethra.     It  occurs  most  fre- 


URINARY    APPARATUS.  179 

quently  in  red  water,  acute  nephritis,  renal  calculi,  hemor- 
rhagic infarction  of  the  kidney,  pyelonephritis,  acute  cystitis 
cystic  calculi. 

Hemoglobinuria  consists  in  the  presence  of  hemoglobin 
(without  the  blood  corpuscles)  in  the  urine.  The  coloring 
matter  is  derived  either  from  the  blood  or  the  muscles.  Ac*^ 
cordingly  we  distinguish: 

a.  Hematogenic  or  toxemic  hemoglobinuria  in  red- 
water  of  cattle  and  in  Texas  fever,  also  in  bad  cases  of  pois- 
oning which  cause  decomposition  of  the  red  corpuscles  in 
extensive  burns  and  in  the  course  of  severe  infectious  dis- 
eases. 

b.  Myogenic  or  rheumatic  hemoglobinuria   in  azoturia. 

c.  Indican  —  indoxyl  sulphate  of  potash  Q  H^  N  K 
S  O4,  occurs  in  all  urine  in  moderate  amount.  It  is  de- 
rived from  the  indol  QH,N  formed  in  the  alimentary  canal 
during  putrefaction  of  albumin;  indol  is  oxydized  into  in- 
doxyl CsH.N  O  H  and  then  combines  with  sulphate  of 
potash  to  form  indoxyl  sulphate  of  potash  — mdiczn.  The 
urine  of  the  horse  contains  on  an  average,  184  mg.  per  liter. 

If  rapid  putrefaction  of  albuminous  substances  takes 
place  in  the  alimentary  canal  the  amount  of  indican  is  in- 
creased; this  is  particularly  the  case  in  digestive  disorders 
accompanied  with  diminished  peristalsis,  digestion  and  ab- 
sorption. Constipation  of  the  ileum  produces  the  largest 
amount  of  indican;  impaction  of  the  colon  on  the  other  hand, 
is  attended  with  much  less  indican  formation. 

Diarrhea  is  attended  with  diminished  indican  formation. 

^n.  '^^/•*  ^°/-  I"  d  i  c  a  n  .  Mix  equal  parts  of  urine  and 
pure  nitnc  acid  in  a  test  tube,  shake  well;  then  add,  drop  by  drop 
followed  by  repeated  shaking,  a  fresh  solution  of  chloride  of  lime' 
this_  causes  the  formation  and  precipitation  of  indigo,  recognized 
by  Its  blue  color.  The  addition  of  chloroform  followed  by  thor- 
ough agitation,  dissolves  the  indigo  and  the  resultant  blue  solution 
settles  at  the  bottom  of  the  test  tube. 


180  CLINICAL    DIAGNOSTICS. 

Quantitative  Determination,  according  to 
Bauer.  Take  20  cc  of  the  urine,  slightly  acidulated  with  acetic 
acid,  precipitate  with  two,  or  if  necessary,  with  four  cc  of  a  20% 
solution  of  acetate  of  lead,  filter  through  a  dry  filter  paper;  take 
11  or  12  cc  (enough  to  represent  10  cc  of  urine)  of  the  filtrate 
and  add  an  equal  volume  of  Obermayer's  Reagent  (solution  of 
chloride  of  iron  in  fuming  hydrochloric  acid  2:1000).  Upon  the 
appearance  of  a  dark  coloration,  always  occurring  in  urine  con- 
taining indican  in  any  quantity,  allow  the  solution  to  stand  a  few 
minutes,  add  20  cc  of  chloroform  and  shake  thoroughly  for  about 
fifteen  seconds.  After  a  short  time,  when  the  chloroform  has 
settled  to  the  bottom  of  the  test  tube  as  a  clear  blue  solution,  pour 
a  portion  of  the  chloroform  into  an  absorption-test-vessel  of  4mm 
depth,  place  the  vessel  upon  a  piece  of  paper  adjacent  to  the  colors 
in  tlie  table,  and  by  comparison  determine  which  solution  lias  a 
corresponding  amount  of  indican.  If  the  color  corresponds  in 
shade  to  that  given  in  plate  I,  the  urine  contains  50  mg  of  indigo 
blue  per  liter,  if  it  corresponds  to  the  shade  indicated  in  plate  II, 
it  contains  100  mg  per  liter,  etc.  If  the  shade  is  darker  than 
indicated  in  plate  VI,  add  an  equal  volume  of  distilled  water,  or,, 
if  necessary,  several  volumes;  make  comparisons  as  explained  and 
multiply  the  result  with  two,  three,  etc.,  as  the  case  may  be. 

d.  Bile  Pigments.  Choleurea.  Under  normal  condi- 
tions bile  pigments  do  not  occur  in  the  blood  of  animals 
and  are  therefore  also  absent  in  the  urine.  Bile  pigments 
are  always  formed  in  the  liver ;  if  in  the  course  of  disease 
they  are  found  in  the  blood  (cholemia)  or  in  the  urine 
(choluria)  they  must  have  originated  in  the  liver.  Bile 
passes  into  the  blood  as  a  result  of  the  congestion  of  bile 
in  the  larger  bile  ducts  from  whence  it  passes  through  the 
lymphatics  to  the  thoracic  duct  and  the  general   circulation. 

Of  the  bile  pigments,  bilirubin  alone  occurs  in  the  urine ; 
exposure  to  the  air  may  convert  this  into  biliverdin.  Urine 
containing  bile  pigments  is  usually  of  a  dark  color,  golden 
yellow,  yellowish  brown  or  greenish  yellow,  and  the  foam  is 
yellow.  The  foam  of  urine  free  from  admixture  of  bile  pig- 
ments is  white. 

Test  for  bile  pigments.  For  the  qualitative  deter- 
mination of  bile,  we  make  use  of  Gmelin's  test.  Into  a  test  tube 
containing  about  three  cc  of  concentrated  nitric  acid  with  an  ad- 


URINARY    APPARATUS.  igi 

g?fen  coo  alo'nrl  .'°"?'^-  °'  ^'^^  ^^^°  ^'^^'^s,  of  which  The 
gicen    color   alone    is   characteristic. 

and  leiter  methods  't',  °'f "?,"'''"  ^"^  ^^^"  superseded  by  newer 
<tna  Detter  methods.     The  following  are  recommended: 

Rosenbach's  test.     Filter  the   urine   through   a   piece   of  white 

o  nitHc'"cid°  U  'wr  •'"'  ''''''''"'  "^^'^  ^h^  —  add  a  drop 
or  nitric  acid  If  bile  pigments  are  present,  the  characteristic 
color  rings  will  appear  encircling  the  drop.  ^naracten.tic 

According    to    Dragendorf,    this    test    i-;    neatly    performed    by 

t/T^  '^!?-'  °V^^"""^  °"  ^  P°'-°"^  plate  of  eartl^enware 
and   then  adding  the  nitric  acid  as  above.  ^aruienware 

^.ii  ^^l^^T^^','f  ^^/V"^'"  sometimes  give  results  when  other  tests 
fail.  Add  milk  of  hme  or  calcium  chloride  to  the  urine  collect 
the    precipitate    by    hltration,   wash    with    a    stream   of   wat^r      hen 

?"lS7anS\e:t"'RT'r''%^"  hydrochloric  acid  and  aicohol 
(o.lOO)  and  heat.  Bilirubin,  if  present,  is  oxidized  into  biliverdin 
producing   a    green    color.  i\eruin, 

Choleuria  occurs:  In  retention  of  bile  in  the  liver 
as  a  result  of  occlusion  of  the  ductus  choledochus  in  duodenal 
catarrh,  presence  of  tumors,  parasites,  concrements. 

In  lupinosis  and  phosphorus  poisoning  as  a  result  of 
swelling  of  the  liver  and  obstruction  of  the  bile  ducts. 

In  all  of  these  cases  the  feces  are  deficient  in  normal  bile 
contents  and  as  a  result  appear  of  a  lighter  color. 

When  the  bile  secreted  is  of  abnormal  consistency 
(hypercholia),  its  flow  is  interrupted  and  stagnation  occurs. 
This  results  in  the  course  of  the  destruction  of  large  num- 
bers^  of  red  blood  corpuscles  ;  also  in  the  course  of  haemo- 
globinaemia,  lumbago,  septicemia,  pyemia,  burns,  internal 
hemorrhage,  prolonged  chloroform  narcosis  and  similar 
poisonings.  In  addition  to  choleuria  the  feces  also  contain 
much  bile. 


183 


CLINICAL    DIAGNOSTICS. 


Fig.  41. 


e.  Grape  sugar,  Glycosuria,  by  means  ordi- 
naril}-  employed  can  be  detect- 
ed in  urine  in  disease  only,  viz. 
in  diabetes  mellitus.  In  horses 
this  disease  has  been  observed  in  a  few- 
instances  only,  in  dogs  it  is  common.  We 
suspect  the  presence  of  sugar  in  polyuria 
when  the  specific  gravity  of  the  urine  is 
high. 

Chemical  determination.  If  albumin  is 
present  this  must  first  be  removed  by  adding 
acetic  acid,  boiling,  and  filtering.  Then  add 
to  10  cc  urine  1  cc  caustic  potash  solution;  if 
this  produces  cloudiness,  filter  again.  Then 
add  about  3  drops  of  a  10%  solution  of  sul- 
phate of  copper.  The  appearance  of  a  light 
blue  color  is  in  itself  an  indication  of  grape 
sugar;  now  heat  the  fluid,  if  grape  sugar  is 
present  an  orange  yellow  precipitate  which 
gradually  extends  downward  is  formed  at  the 
surface;  this  is  an  oxide  of  copper. 

This  test   (Trommer's  test) 

is   by   no   means   reliable  for   horse 

urine  because   the   latter   contains   other  bodies   that   have   a 

reducing   power:      Pyrocatcchiii,    etc.      On    the    other    hand, 

substances  that  prevent  the  reduction    (or  precipitation)    of 

oxide  of  copper  may  be  present.     Pure  grape  sugar,  when 

added  to  horse  urine,  can  sometimes  not  be  detected  at  all 

by  means  of  Trommer's  test.     In  all  cases  of  doubt  we  must 

therefore  resort  to  the  fermentation  test,  as  follows : 

Boil  20  cc  of  urine  that  has  been  freed  from  albumin,  let  cool 
and  add  a  piece  of  baker's  j^east  as  large  as  a  pea,  shake  thorough- 
ly, pour  into  a  fermentation  tube  and  close  the  latter  with  metallic 
mercury.  Keep  the  tube  at  room  temperature  for  24-48  hours.  If 
sugar  is  present  fermentation  will  set  in  and  the  C0„  thus  pro- 
duced will  collect  in  the  top  of  the  tube  where  the  percentage  is 
indicated  by  a  graduated  scale. 

Ce  Hi2  Oe  =  2C.,  H,  OH.,  -f  C  C, 
Grape  sugar  =  alcohi  1  +  carbondioxide. 

This   test   can  of  course   be   relied   upon   only   when   we 


Fermentation  tube. 


URIXARY    APPARATUS.  183 

are  assured  of  the  quality  of  the  yeast  and  that  it  is   free 
from  traces  of  sugar. 

The^phenylhydrazin  test  (C6H8N2)  of  V.  Jacksch  (Modifica- 
tion of  Esch'baum)  is  very  reliable  for  the  urine  of  the  dog  (Regen- 
bogen).  Mix  5  drops  of  phenylhydrazin.  20  drops  of  glacial  acetic 
acid  and  50  drops  of  urine  in  a  test  tube  and  boil  gently  for  one 
minute;  add  25  drops  of  officinal  sodium  hydrate  solution  and 
again  raise  to  boiling  point,  .^llow  the  mixture  to  settle  for  12-24 
hours  and  then  make  a  microscopic  examination  of  the  sediment. 
If  the  urine  contained  sugar  bunches  of  yellow,  needle-like  crystals 
of  phenylglukosazone  will  be  found. 

Fig.  42. 


Carbonate  of  Lime. 

Lactose  occurs  in  the  urine  of  cows  advanced  in  preg- 
nancy, disappears  after  calving  and  reappears  when  the  milk 
ducts  become  obstructed. 
C.   Alicroscopical  Examination  oft  he  Urine. 

If  the  examination  thus  far  conducted  reveals  any  im- 
portant alterations,  we  complete  the  same  with  the  micro- 
scope. A  m  i  c  r  o  s  c  o  p  i  c  e  X  a  m  i  n  a  t  i  o  n  o  f  t  h  e  u  r  i  n  e 
in  diseases  of  the  urinar\'  organs  is  of  even 
greater  importance  than  a  chemical  analy- 
sis. 


184  CLINICAL    DIAGNOSTICS. 

Method.  Pour  some  of  the  urine  into  a  conical  glass,  previ- 
ously stirring  the  same  with  a  glass  rod  to  be  sure  to  get  an 
average  sample.  The  urine  is  then  set  away  to  allow  the  solid 
particles  to  settle  out;  with  horse  urine  this  is  a  rather  slow 
process.  To  prevent  decomposition  during  the  process  of  sedi- 
mentation, add  a  few  drops  of  chloroform.  Remove  some  of  the 
sediment  with  a  pipette  and  examine  a  drop  on  a  slide,  under 
the  microscope. 

A.     Crystalline  Constituents  of  Urine. 

The  reaction  of  the  urine  itself  gives  us  a  certain  clue 
as  to  the  character  of  the  sediments.  The  normal  alkaline 
ttrine  of  herbivora  contains  (see  p.  151)  carbonate  of 
lime  and  small  quantities  of  neutral  phosphates  Ca.jCPO^),. 
Such  sediment  does  not  dissolve  when  heat  is  applied,  but  the 
.-addition  of  hydrochloric  acid  produces  solution,  and  develop- 
ment of  COo.  The  sediment  which  forms  in  the  acid  urine 
■of  carnivora  consists  of  acid  urates  and  acid  phos- 
phates which  dissolve  on  being  heated. 

To  determine  accurately  the  nature  of  the  crystalline 
sediment  a  microscopical  examination  must  be  made ;  the 
forms  of  the  crystals  indicate  their  nature.  Amorphous  salts 
■can  be  recognized  by  micro-chemical  tests  only. 

a.  Carbonate  of  lime  crystallizes  in  globules  with  radi- 
ate markings,  if  the  globules  are  large  a  concentric  marking 


Oxalate  of  Lime.  Uric  Acid. 

can  also  be  observed.  Carbonate  of  lime  crystals  also  occur 
in  form  of  breakfast  rolls,  dumb-bells,  whetstones  and 
crosses.      Amorphous   powder   of   carbonate   of    lime   can    be 


URINARY    APPARATUS. 


185 


recognized  by  the  fact  that  the  addition  of  acetic  acid  causes 
an  evokition  of  gas. 

b.  Oxalate  of  lime  crystallizes  in  scjuare  octahedra  that 
have  strong  light-refracting  power,  other  forms  occur  but 
are  not  characteristic.  Acetic  acid  d:es  not  affect  oxalate 
of  lime,  hydrochloric  acid  dissolves  it.  It  occurs  in  small 
quantities  in  alka:line  urine,  to  a  greater  extent  in  acid  urine, 
but  is  of  no  importance  for  diagnostic  purposes. 

c.  Uric  acid  and  its  salts  are  normal  constituents  of 
the  urine  of  carnivora  but  traces  of  them  also  occur  in  the 
urine   of  herbivora. 

They  commonly  occur  as  an  amorphous  powder  or  in 
the  form  of  crystals ;  whetstone,  rhombic  plates,  pointed  crys- 


Pig.  45. 


Hippuric  Acid. 


Triplephosphate  Crystals. 


tals,  frequently  occurring  in  the  form  of  minute  druses.  A 
characteristic  consists  in  the  peculiarity  that,  on  crystallizing, 
they  attract  the  pigment  of  the  urine  which  gives  them  a 
yellowish  brown  color.  They  dissolve  in  a  solution  of  caus- 
tic potash,  and  they  are  precipitated  in  the  form  of  rhombic 
prisms  by  the  addition  of  hydrochloric  acid. 

d.  Hippuric  acid  and  its  salts  form  rhombic  quadrilat- 
eral prisms  and  needles  which  dissolve  in  hydrochloric  acid. 
Normal  constituent  of  urine  of  horses. 


186 


CLINICAL    DLXGNOSTICS. 


e.  Triple  phosphate  of  ammonia  and  magnesia   PO^ 

MgNH^  crystallizes  in  coffin-lid  forms,  dissolves  in  acetic 
acid  without  giving  off  gas.  Does  not  occur  normally  in 
freshly  voided  urine,  but  always  forms  when  urine  is  exposed 
to  the  air  for  some  time  {fermentation).  If  found  in  fresh 
urine  it  indicates  that  ammoniacal  fermentation  has  taken 
place  in  the  bladder,   cystitis,  pyelitis. 

f.  Sulphate  of  lime,  gypsum,  occurs  occasionally  and 
in  small  quantity  in  the  form  of  columnar  prisms  or  plates 
in  acid  urine.  It  is  abundant  after  internal  administration  of 
sulphates    (Glauber  salts).      Of  no  importance. 

B.     Organized  Elements  of  Urine. 

In  the  diagnosis  of  diseases  of  the  urinary  organs  these 
are  of  the  greatest  importance.     The  addition  of  Lugol's  So- 


Fig.  47. 


Sulphate  of  Lime. 


lution  to  the  sediment  is  an  aid  in  recognizing  the  cellular 
elements  under  the  microscope. 

g.  Epithelial  cells  in  small  number  are  found  in 
normal  urine,  occasionally  we  find  two  or  three  pavement 
epithelial  cells  in  one  cover  glass  preparation.  On  the  other 
hand  the  finding  of  epithelial  cells  from  the  uriniferoiT^  tul)- 


URINARY    APPARATUS.  187 

ules  (renal  epithelia)  is  an  exception  under  these  conditions. 
Marked  increase  of  epithelial  cells  is  due  to  a  pathological 
desquamation,  hence  is  observed  in  catarrhs  and  inflammation 
of  the  membranes  concerned.  It  is  important  to 
be  able  to  recognize  the  origin  of  the 
cells     b}^     their     for  m. 

Renal  epithelium  is  roundish  or  more  or  less 
cubical  and  granulated  with  proportionately  large  granules 
and  is  much  smaller  than  the  pavement  epithelium  of 
the  pelvis  of  the  kidney,  the  urethra  and  the  bladder.  They 
occur  singly  or  several  united  and  not  infrequently  show  signs, 
of  fatty  degeneration.  Their  occurrence  indicates  a  renal 
affection,  but  whether  or  not  inflammation  exists  must  be  de- 
termined by  further  examination  of  the  urine. 

Pavement  epithelia  from  the  pelvis  of  the 
kidney,  the  urethra  and  the  bladder  resemble  each  other  and 
cannot  be  distinguished  as  to  their  particular  source.  They 
are  large,  flat,  polygonal,  transparent,  nucleated  pavement 
cells.  Those  coming  from  the  surface  layers  of  the  mucous 
membrane  are  more  roundish  or  polygonal,  those  from  the 
deeper  layers  are  more  oval,  or  cone  shaped  and  may  contain 
one  or  more  protoplasmic  projections  that  give  them  a  toothed 
appearance.  If  a  considerable  number  of  such  cells  are  pres- 
ent a  catarrhal  condition  of  the  corresponding  mucous  mem- 
branes is  indicated. 

h.  White  blood  corpuscles  or  pus  cocci  are  spherical, 
granulated,  nucleated  cells  that  are  cleared  or  become  trans- 
parent when  treated  with  acetic  acid.  They  may  have  come 
from  the  kidneys  or  from  the  urinary  tract;  if  from  the  kid- 
neys we  also  find  casts,  if  they  occur  simultaneously 
with  numerous  pavement  epithelia  and  crystals  of  triplephos- 
phate  they  come  from  the  bladder. 


188  CLINICAL    DIAGNOSTICS. 

i.  Red  blood  corpuscles,  when  found  in  the  urine, 
have  lost  most  of  their  coloring  matter,  are  pale  and  swollen. 
Those  coming  from  the  upper  portions  of  the  urinary  tract 
have  undergone  these  changes  to  a  greater  extent  than  those 
■coming  from  the  lower  portions.  Thorough  admixture  of  red 
corpuscles  with  the  urine,  thus  retarding  sedimentation  of  the 
former,  points  to  renal  hemorrhage ;  blood  casts  always  point 
to  renal  hemorrhage.  Large  masses  or  clots  of  blood,  not  thor- 
oughly mixed  with  the  urine,  come  from  the  bladder.  An 
admixture  of  blood  with  the  urine  (hematuria)  occurs  in: 

1.  Diseases  of  the  kidneys:  injuries,  hem- 
orrhagic nephritis,  embolic  nephritis ; 

2.  Diseases  of  the  urinary  tract :  pyelone])hritis,  cys- 
titis, red  water  of  cattle,  cystic  calculi,  cystic  tumors,  in- 
juries of  the  urethra. 

k.  Urinary  casts  are  cylindrical  bodies  that  were 
molded  in  the  lumen  of  the  uriniferous  tubules.  In  the  urine 
of  the  horse  we  find  similar  structures  under  normal  condi- 
tions ;  they  consist  of  strings  of  mucus  of  variable  thickness, 
sometimes  macroscopically  visible  and  granulated  with  de- 
posits of  amorphous  carbonate  of  lime.  Addition  of  acetic 
acid  causes  the  granules  to  disappear  with  the  formation  of 
COo.  In  acid  urine  we  find  uric  acid  salts  instead.  These  so 
called  grannie  casts,  lime  casts,  or  cylindcroids  have  noth- 
ing whatever  in  common  with  true  urinary  casts.  They 
are  especially  common  in  the  transition  stage  from  oliguria  to 
polyuria. 

The  true  urinary  casts  are  distinguished  as  follows: 

1.  Hyaline  casts,  slender,  transparent,  homogeneous 
bodies  of  various  sizes  and  not  sharply  defined  contour.  They 
are  rare,  occur  in  health  as  well  as  in  disease,  are  of  no  diag- 
nostic importance  and  their  origin  is  unknown. 


URINARY    APPARATUS. 


189' 


Fig. 


Granular  Casts. 


Fig.  48.  2.     Epithelial  casts  consist  of  renal  epithelia 

agglutinated  with  exudates  and  forced  out  of  the 
tubules  by  the  pressure  of  the 
urine  above  them.  Frequently 
red  and  white  blood  corpuscles 
are  associated  with  them.  Such 
cylinders,  providing  they  occur 
in  any  appreciable  numbers,  'al- 
ways indicate  inflammation  of 
the  kidneys.  These  epithelial 
cells  may  also  have  undergone 
fatty  degeneration.  If  they  con- 
Epitheiiai       tain    no    cells    they    are    called 

Casts.  -^ 

granular    casts,    and    have    the 
same  significance  as  the  epithelial  cylinders. 

3.  Blood  corpuscle  casts  are  formed  of  agglutinated  red 
corpuscles  and  are  due  to  renal  hemorrhage.  If  these  casts 
contain  many  white  corpuscles  they  indicate  purulent  inflam- 
mation (pits-casts). 

1.  Examination  for  micro-organisms  is  of  value  in 
case  of  fresh  urine  only,  because  urine  that  has  been  standing 
for  some  time  will  soon  become  filled  with  great  masses  of 
bacteria  and  mold  fungi  from  the  air.  Large  numbers  of 
bacteria  in  fresh  urine  occur  in  pyelonephritis  bacteritica  and 
in   chronic   cystitis. 

Bacillus  pyelonephritis  bovis  will  stain  according  to  Gram's 
method.  A  cover  glass  preparation  is  made  from  the  sediment 
of  the  urine,  stained  with  gentian  violet,  rinsed  with  water,  a  few 
drops  of  Lugol's  solution  (lod.  8,  Pot.  lod.  4,  Aqua  100)  added, 
then  decolorized  in  alcohol.  All  bacteria  that  stain  according  to 
Gram's  method  have  now  assumed  a  deep  blue  color;  while  all 
the  rest  are  decolorized.  Bac.  pyeloneph.  appears  as  a  rod  with 
rounded  ends,  2-3u  long  and  0.7u  in  diameter,  evenly  stained  and 
usually   occurring  in   little   groups. 

III.     Examination  of  the  Urinary  Organs. 

Topography.  In  the  horse  and  cow  the  leftkid- 
ney  only  is  accessible  for  palpation  from  the 
re  c  t  u  m  ,     the  right  kidney  lies  further  forward  and  cannot  be 


190  CLINICAL    DIAGNOSTICS. 

reached  by  the  hand.  In  the  horse  the  left  kidney  extends  back 
to  about  four  inches  behind  the  last  rib  and  its  inner  border  is 
separated  from  the  median  line  by  about  the  same  distance.  In 
the  ox  it  is  loosely  suspended  below  the  lateral  processes  of  the 
first  lumber  vertebrae.  Sometimes  it  may  be  shifted  over  to  the 
right  side.  In  the  dog  the  kidneys  lie  in  the  lumbar  region,  the 
right  somewhat  more  anterior  than  the  left;  hence  the  left  kidney 
can  be  more  easily  felt  from  the  outside  than  the  right  kidney. 

In  palpating  thekidneys  follow  the  general 
rules  for  this  method  of  examination  (see  p.  23).  In  pyelone- 
phritis of  the  ox  the  kidneys  are  enlarged  and  firm,  the  ureters 
distended  and  their  walls  thickened  and  firm. 

Examination  of  the  bladder,  per  rectum, 
in  the  horse  and  ox.  is  quite  practicable ;  in  the  dog  the  ex- 
amination must  be  made  by  external  palpation.  The  extent 
to  which  the  bladder  is  filled  is  of  importance ;  if  empty,  in  the 
horse  and  cow,  it  represents  a  soft  pearshaped  body  lying  on 
the  floor  of  the  pelvis.  If  well  filled  it  can  be  felt  as  a"  dis- 
tended body  projecting  far  beyond  the  anterior  border  of  the 
pelvis.  To  feel  it  the  hand  need  not  be  inserted  much  fur- 
ther than  to  the  wrist.  The  contents  of  the  bladder  can  be 
removed  by  a  steady  but  moderate  pressure  applied  with  the 
hand,  or  by  means  of  the  catheter;  this  may  be  important  to 
determine  whether  evacuation  is  possible.  If  the  bladder  is 
ruptured,  which  is  most  common  in  oxen  with  urethral  calculi, 
it  is  permanently  small  and  flabby. 

Cystic  calculi  and  tumors  in  the  bladder  can  be  recog- 
nized with  certainty  only  when  this  organ  contains  little  or 
no  fluid  contents. 

Examination  of  the  urethra  is  of  conse- 
quence in  male  animals,  particularly  in  oxen,  when  the  pres- 
ence of  calculi  may  be  suspected.  As  a  rule  these  are  lodged 
in  the  upper  or  lower  portion  of  the  S  shaped  curve.  ,  Pressure 
exerted  at  the  point  where  the  obstruction  is  located  produces 
pain.  As  long  as  the  bladder  is  not  ruptured  urine  may  drib- 
ble from  the  distended  urethra.  Unfortunately  catheteriza- 
tion is  impossible  in  the  ox  (sharp  curves  and  narrow  lumen 


URINARY    APPARATUS.  191 

of  urethra)  ;  in  the  horse  and  dog  this  examination  is  easy 
and  rehable. 

Diseases  of  the   Urinary   Apparatus. 

Passive  hyperaemia  of  the  kidneys  occurs  as  a  result  of  chronic 
heart  and  lung  troubles.  Urine  is  decreased,  sp.  gr.  increased, 
albumin  present.     Symptoms  more  conspicuous  after  exertions. 

Acute  diffuse  nephritis.  This  is  primary  only  in  cases  of 
poisoning  with  irritating  substances,  otherwise  it  is  a  symptom 
of  severe  infections.  Dysuria,  stranguria,  pain  in  the- region  of 
the  kidneys,  stiff  gait  and  crooked  back.  Considerable  diminu- 
tion of  renal  secretion  (anuria),  thick  and  viscid,  turbid,  high  sp. 
gr.,  acid,  much  albumin.  Microscopic  examination  most  important: 
granular  casts,  renal  epithclia  and  blood  corpuscles.  Stupefaction, 
difficult  breathing,  oedematous  swellings. 

Nephritis  suppurativa.  Secondary  affection  and  usuallv  of  less 
importance  than  the  primary  disease.  Intermittent  fever.' exhaus- 
tion, emaciation,  urine  contains  albumin,  pus  corpuscles  and  micro- 
organisms. 

Chronic  nephritis.  No  fever,  develops  very  slowly.  Anorexia, 
exhaustion,  emaciation.  Pulse  strong  and  hard,  heart  hypertro- 
phied.  Increased  amount  of  urine,  low  sp.  gr.,  amount  of  albumin 
slight,  few  epithelial  cells  and  casts. 

Cystitis,  inflammation  of  the  bladder.  Continuous  efforts  to 
urinate,  hence  small  quantities  or  only  a  few  drops  are  voided  at 
a  time.  Urination  painful,  restlessness,  groaning,  animals  remain 
for  a  long  time  in  a  "urinating  attitude."  Urine  cloudy,  alkaline, 
slimy  or  purulent  sediment,  ammoniacal  odor.  Pus  corpuscles, 
red  blood  corpuscles,  numerous  pavement  epithelia,  phosphate  of 
ammonia  and  magnesia. 

Retentio  urinae.  Retention  of  urine.  Complete  (ischuria)  or 
partial  suppression  of  urination;  in  the  latter  case  it  is  voided  in 
drops  and  with  symptoms  of  pain.  Palpation  of  the  bladder  very 
important:  distention,  pain  on  pressure.  Animals  indisposed,  in- 
active, do  not  lie  down,  appetite  diminished,  pulse  increased, 
sweating.  After  rupture  of  bladder  has  occurred  the  pains  disap- 
pear, animals  feel  more  at  ease,  bladder  is  empty.  Then  come 
chills,  higii   fever,  urinous   odor   of  transpired  air.  *    • 

Incontinentia  urinae.  Paralysis  of  bladder.  Involuntary  flow 
of  urine,  especially  during  motion. 

Hematuria  is  a  chronic  productive  cystitis  of  the  ox,  with 
tendency  to  hemorrhage.     Blood  corpuscles  and  clots  in  the  urine. 

Hemoglobinuria  of  the  ox.  Hemoglobinemia.  Fever,  par- 
tial loss  of  appetite,  diarrhea.  Urine  light  red  to  dark  red,  foams 
readily,  urination  painful,  reaction  at  first  acid,  later  on  alkaline, 
contains  hemoglobin,  on  boiling  coagulates  as  gelatinous  mass. 

Pyelonephritis  bacteritica  boum.  This  is  a  chronic  purulent 
inflammation  of  the  ureters  and  pelvis  of  the  kidneys  which  spreads 


192  CLINICAL    DIAGNOSTICS. 

to  the  kidneys  and  is  caused  by  a  specific  bacillus.  Gradual  ema- 
ciation and  general  depression.  Intermittent  fever.  Urine  thick 
and  slimy,  cloudy,  gra}'  or  grayish  brown,  white  and  red  blood 
corpuscles,  casts,  numerous  pavement  epithelia,  crystals  of  triple 
phosphate,  and  bacilli,  Bacillus  pyelonephritidis  boum.  Stain 
according  to  Gram,  2-3  micra  long,  O.G-0.7  micra  in  diameter,  non- 
motile,  straight  or  slightly  bent,  rounded  at  the  ends. 

Diseases    of    Tissue    Metabolism. 

Diabetes  insipidus,  polyuria,  pissing,  is  an  independent  disease 

in  which  hirge  quantities  of  clear  watery  urine  are  passed  continu- 
ously. Daily  quantity  of  urine  passed  equaling  as  high  as  30  liters. 
Urine  as  clear  as  water  or  slightly  yellow,  acid,  sp.  gr.  1001-1010, 
no  albumin,  little  indican.  Diminished  appetite,  desire  for  alkalies, 
[earth,   etc.]    emaciation. 

Diabetes  mellitus,  sugar  in  the  urine,  is  very  rare  in  horses, 
more  common  in  dogs.  Polyuria,  ravenous  appetite  and  thirst, 
rapid  emaciation.  Urine  has  high  sp.  gr.,  1024-1045,  and  contains 
grape  sugar. 

10.     The  Sexual  Apparatus. 

Most  of  the  organs  of  the  sexual  apparatus  may,  for  the 
greater  part,  be  subjected  to  direct  inspection  and  palpation; 
their  examination  should  be  conducted  according  to  general 
rules,  care  being  observed  that  no  parts  arc  overlooked.  For 
evident' reasons  the  female  sexual  organs  are  more  frequently 
affected  with  diseases  than  those  of  the  male.  Most  of  these 
diseases  belong  to  the  field  of  obstetrics. 

I.  Abnormally  increased  sexual  desire  manifests  it- 
self not  only  by  sexual  excitement  but  also  by  psychic  disturb- 
ances and  altered  sensibility,  these  often  resembling  diseases 
of  the  central  nervous  system.  In  females  this  condition  is 
known  as  nymphomania,  in  males  as  satyriasis;  continued 
erections  of  the  penis  is  called  priapism. 

]\I  a  r  e  s  are  usually  very  ticklish  and  easily  excited,  if 
touched  with  the  hand  or  harness  they  squeak  or  cry  out, 
switch  their  tail,  back  up  against  persons  or  against  the 
wagon  tongue,  kick,  urinate,  and  can  be  used  for  their  regu- 
lar work  only  when  special  care  is  exercised.  In  rare  cases 
they  may  act  like  dummies  (general  depression  of  the  senso- 
rium)  and  show  symptoms  of  hyperesthesia. 


SEXUAL   APPARATUS.  193 

Cows  show  symptoms  of  great  restlessness,  are  very 
excitable,  bellow  frequently,  attack  strangers,  etc.  Milk  se- 
cretion is  reduced,  the  milk  has  a  bad  taste  and  sometimes 
curdles  when  boiled. 

In  horses  and  bulls  satyriasis  manifests  itself  by 
restlessness  and  excitable,  sometimes  vicious,  actions. 

In  many  cases  the  cause  of  these  conditions  cannot  be  as- 
certained ;  in  cows  tuberculosis  of  the  ovaries,  in  horses  cryp- 
torchism,  is  often  the  cause. 

A.  Female  Sexual  Organs. 

II.  The  vulva.  In  bitches  we  observe  swelling  of  the  vulva' 
and  a  bloody  mucous  discharge  at  the^oestral  period.  In  cows  a 
tough  glassy  mucus  is  discharged  just  before  parturition.  This 
mucus  comes  from  the  neck  of  the  uterus  which  it  served  to  close. 

A  slight  swelling  of  the  vulva  occurs  in  vesicular  eruption 
of  this  region ;  small  vesicles  the  size  of  a  millet  seed,  and 
swelling  may  also  occur  in  the  adjacent  skin  in  this  condition. 
In  puerperal  septicemia  the  vulva  swells  conspicuouslv. 

In  torsion  of  the  uterus  the  vulva  is  retracted  and 
drawn  into  folds;  however,  exploration  per  vagina 
is  necessary  to  definitely  determine  this  condition. 

Discharge  from  the  inferior  commis- 
sure of  the  V  u  1  V  a  and  soiling  of  the  surroimding  skin 
and  tail  are  observed  in: 

a.  Catarrh  of  the  vagina  and  uterus.  In  chronic  catarrh 
(fluor  albus)  the  discharge  is  of  a  thick  shmy  character 
and  glassy ;  in  acute  catarrh  the  discharge  is  of  a  thin  slimy 
character  and  discolored. 

b.  Retention  of  the  afterbirth;  an  ill-smelling,  discolored 
fluid  mixed  with  fragments  of  the  fetal  membranes  is  dis- 
charged. 

c.  Vesicular  eruption ;  the  discharge  is  slight,  slimy  or 
purulent,  sometimes  mixed  with  blood. 

d.  Tuberculosis ;  slight,  chronic,  muco-purulent  discharge 
containing     tubercle     bacilli. 


194  CLINICAL    DLVGXOSTICS. 

III.  Vaginal  mucous  membrane.     Whenever  there  is 

discharge    from    the    vagina    the    vaginal    mucous   membrane 

should  be  examined. 

Method.  Grasp  the  tail  near  its  root,  raise  it  well  up,  and  let 
it  rest  on  the  back  of  the  other  hand,  thus  leaving  the  lingers  of 
that  hand  free  to  open  the  lips  of  the  vulva.  In  order  to  examine 
■deeper-lying  parts -an  assistant  should  hold  the  tail  and  the  opera- 
tor can  then  insert  his  whole  hand,  which  must  be  previously 
covered  with  oil.  After  thorough  palpation  in  this  manner  the 
other  hand  may  also  be  inserted,  the  vaginal  walls  spread  apart, 
and  their  mucous  membrane  inspected;  here  artificial  light  maj^  be 
of  advantage.  A  vaginal  speculum  is  not  absolutely  necessary  for 
these  examinations. 

By  means  of  direct  examinations  like  these,  affections  of 
the  vagina  can  best  be  observed  and  their  character  deter- 
mined. In  vesicular  eruption  yellowish  gray  nod- 
ules, vesicles  or  ulcers,  the  size  of  a  millet  seed,  are  found  on 
the  slightly  and  dififusely  reddened  inucous  luembrane.  After 
healing,  light  specks  that  indicate  the  position  of  former  vesi- 
cles and  ulcers  can  be  observed  for  some  time. 

In  torsion  of  the  uterus*  the  vagina  is  con- 
tracted, and  the  mucous  membrane  is  drawn  into  twisted  folds. 
The  examination  of  the  uterus  and  the  explanation  of  changes 
in  that  organ  belong  to  the  field  of  obstetrics. 

IV.  The  udder.  In  the  examination  of  cows 
the  udder  must  never  be  neglected.  In- 
quire at  least  as  to  quantity  and  quality  of  the  milk.  Observe 
the  color  of  the  skin  and  note  an}'  changes  that  may  have  taken 
place.  The  teats  of  cows  and  sheep  may  be  afifected  with 
pox,  in  foot  and  inouth  disease  the  teats  of  cows  may  be  cov- 
ered with  blisters ;  we  also  find  inilk  fistulae.  Observe  also 
the  relative  size  of  the  different  quarters  of  the  udder  and  the 
condition  of  the  surface ;  note  the  size,  position,  and  direction 
of  the  teats.  In  palpation  each  quarter  should  be  sep- 
arately felt,  its  size  and  consistency  noted  and  sensi- 
tive or  kn  o  t  te  d  areas  observed.  The  teats  should  be 
soft  and  the  milk  canal  should  not  be  felt;  if 
thickenings  or  swellings  exist,  their  location,  extent,  size  and 


SEXUAL    APPARATUS.  195 

form  should  be  determined.  Finally,  milk  every  teat  in  order 
to  determine  the  ease  with  which  the  fluid  can  be  drawn,  no- 
tice the  size  of  the  stream  and  the  character  of  the  milk, 
whether  it  is  c  1  o  1 1  e  d  or  bloody:  A  microscopical  ex- 
amination of  abnormal  milk  is  not 
necessary  but  may  be  of  value  in 
some  cases.  To  determine  wheth- 
er a  cow  is  "fresh"  a  microscopical 
examination  of  the  milk  for  the  col- 
ostrum bodies  or  corpuscles  must 
be  made. 

Fig.  50.    Colostral  Milk. 

Harpooning    the    udder    according  to   Ostertag.     The 

operation  may  be  performed  on  the  standing  animal,  but  bet- 
ter results  can  be  obtained  if  the  animal  is  cast  and  secured. 

\\'ash  the  field  of  operation  with  soap  and  water,  rinse 
with  2  per  cent,  lysol  solution, 'following  this  with  50  per 
cent,  alcohol.  With  hooked  forceps  grasp  the  skin  overlying 
the  suspicious  area  in  the  udder  and  at  the  fold  thus  pro- 
duced incise  the  skin  and  underlying  facia  with  scissors,  grasp 
the  tissues  with  the  thumb  and  index  finger  of  the  left  hand 
and  insert  the  harpoon  with  the  right.  When  the  suspected 
tissue  has  been  reached  give  the  harpoon  a  half  turn  and 
withdraw  it  quickly.  The  cutaneous  wound  is  closed  \vith 
artery  forceps  which  are  allowed  to  remain  ten  minutes, 
whereupon  the  wound  is  sealed  with  iodoformcollodion. 

Cows  thus  treated  will  give  bloody  milk  for  a  few  days, 
but  if  carefully  performed  the  operation  is  not  dangerous.' 

Tubercles,  if  contained  in  tissue  thus  removed,  can  usual- 
ly be  recognized  with  the  aid  of  a  simple  lens.  If  the  exam- 
ination gives  negative  results  it  is  advisable  to  repeat  the  op- 
eration. Tubercle  bacilli  can  always  be  demonstrated  in 
the  tubercles. 

In  this  method  a  positive  diagnosis  alone  is  of  anv  value. 
AVe  can  not  rely  upon  negative  results.      This  method  is  of 


196  CLINICAL    DIAGNOSTICS. 

value  in  cases  of  suspected  tuberculosis  where  we  fail  to  get 
a  tuberculin  reaction,  or  when' a  suspected  quarter  is  dry  and 

the  possibility  of  a  direct  examination  of  the  milk  is  excluded. 

Bacteriological  Diagnosis  of  Udder  Tuberculosis  according 
to  Ostertag. 

The  most  reliable  means  of  recognizing  tuberculosis  of 
the  udder  consists  in  the  inoculation  of  Guinea  pigs  with  a 
sample  of  milk  from  the  suspected  udder.  To  obtain  reliable 
results  the  milk  must  be  procured  with  proper  precautions: 
Wash  the  udder  with  warm  water  until  it  is  clean,  follow  this 
with  50  per  cent,  alcohol  and  then  dry  with  absorbent  cotton. 
Discard  the  first  ten  CC  of  milk  drawn. 

One  CC  of  whole  milk  is  used  for  the  inoculation.  Inject 
this  into  the  muscles  of  the  inner  posterior  region  of  the  thigh. 
Upon  the  appearance  of  firm,  hard,  painless  and  well  defined 
nodules  the  size  of  small  peas  or  larger,  representing  the  lymph 
glands  near  the  point  of  inoculation,  the  animals  may  be 
killed.  Ihese  nodules  may  appear  as  early  as  the  tenth  day 
after  inoculation.  If  the  nodules  do  not  make  their  appear- 
ance, the  Guinea  pigs  are  killed  at  the  end  of  six  weeks.  The 
presence  of  tubercle  bacilli  in  the  lymphatic  glands  or  in  the 
internal  organs  demonstrates  the  existence  of  tuberculosis. 

V>.  ]\r  a  1  e  Sexual  Organs. 
V.  Diseases  of  the  male  sexual  organs  are  usually  of 
a  surgical  nature.  In  vesicular  eruption  we  find  vesicles,  pus- 
tules and  ulcers,  or  scars,  on  the  penis.  To  examine  stallions 
or  bulls  they  may  be  led  up  to  a  mare  (or  cow)  which  usual- 
ly results  in  voluntary  protrusion  of  the  organ.  In  bulls 
manipulation  with  the  hand  may  answer  the  same  purpose.  In 
glanders  the  testicles  may  reveal  the  presence  of  knots. 

Diseases  of  the  Sexual  Organs. 

Torsio  uteri,  torsion  of  the  womb,  of  interest  in  internal  medi- 
cine only  when  parturition  or  pregnancy  is  excluded.  Animals  are 
restless,  kick  belly  witli  hind  feet  and  have  pains  of  labor.  Exami- 
nation of  vagina  gives  necessarj-  information. 


SEXUAL    APPARATUS.  197 

Vaginitis  (colpitis),  inflammation  of  vagina  Svmntom^  v^rv 
^uch,  accordmg  to  degree  and  character  of  "he  affection  If  i/ 
iiammation  is  severe,  general  health  is  affected  Anir^asm-ikefre' 
quent  attempts  to  urinate;  small  quantities  of  un^  passed  at  a 
time;  anima  s  remain  long  in  a  "urmating  attitude  "  Examhiat  on 
of  vagina  gives  necessary  information.  Examination 

_  Endometritis,  inflammation  of  the  womb.  Follows  oarturition- 
intensity  ot  disease  varies.  General  health  more  or  ess  disturbed 
fever  discharge  from  vagina  which  varies  according  to  character 
Soiled'nir'exL"  ^'''''f  particularly  when  aniiSaSs  lie  down 
obstllriS'is'lJwayfindic^/ter"'    ^"°^''"^    ^°   ^^""^^    '^'^'    °^ 

Mastitis,  inflammation   of  udder,'  garget. 

3.  Mastitis  i  n  t  e  r  s  t  i  t  i  a  1  i  s  .  Fever  and  hot  rather 
'uSity"'noT"a^tteT^^'"^^  °^  ''''-■     ^"-^^'^>'   ^^  ^^^   ^IcrSlS 

and  ;ia^:  ^,^t^  ^  ^^^^^^l^,  "^^i^^IS^^'^ ^li 

SasTti  i^  "'''-'•  •  f ?"'■•  ^T  °^  ^PP^^'^^-  Infectious  catarrhal 
^eHn  Al  '^special  orm  of  catarrhal  mastitis,  infectious,  milk 
3eIlo\vii,h.     Lsually  all   four  quarters  affected. 

3.  Mastitis  par  en  chyma  to  sa.  As  a  rule  only  one 
quarter  affected.  Fever,  appetite  diminished,  rumination  inter- 
rupted, constipation.  One-quarter  of  the  udder  enlarged,  firm, 
hot,  sensitive.  The  teat  of  the  affected  udder  is  usually  fre^  from 
inflammatory  symptoms,  the  milk  secretion  is  greatly  decreased 
yellowish,  contains  muco-purulent  flakes  which  usually  contain 
numerous   streptococci. 

4.  Mastitis  tuberculosa.  A  few  nodular  enlarge- 
ments, otherwise  the  udder  is  tough  and  flabby.  Sup?a- 
mammary  glands  enlarged.     Tubercle  bacilli  in  milk. 

Vesicular  eruption  [coital  exanthema]  is  an  acute  infectious 
vesicular  exanthema  of  the  mucous  membrane  of  the  vagina  and 
the  penis.  Period  of  incubation  3-6  days.  The  vesicles  develon 
into   httlc  ulcers.  ^ 

Mai  du  coit  [seen  in  U.  S.  in  imported  stallions].  Period  of 
incubation  8  days  to  2  months.  Swelling  of  the  vulva  and  penis 
formation  of  vesicles  and  ulcers.  Frequent  attempts  to  urinate 
increased  sexual  desire,  urticariform  swellings  of  skin,  paralvsis 
of  hind  parts. 

II.     The  Nervous  System. 

Diseases  of  the  central  nervous  system  can  be  recognized 
only  by  the  disturbed  functions  of  its  parts,  a  physical  exam- 
ination of  the  diseased  parts  is  out  of  the  question.  We  must 
therefore  subject  each  function  to  a  careful  examination  and 
■draw  conclusions  as  to  the  parts^  affected  from  the  character 


198  '        CLINICAL    DIAGNOSTICS. 

of  the  disturbed  physiological  processes  and  conditions.      To 

diagnose   diseases   of  the   central   nervous   system   requires   a 

knowledge     of     the     location     of     the     principal 

functions. 

Preliminary  remarks  on  anatomy  and  physiology.  All  efferent 
(motor)  psychic  (conscious  and  volitional)  fibres  originate  in  the 
cortex  of  the  cerebrum,  and  all  sensory  fibres  and  fibres  of  special 
sense  that  conduct  perceptible  impulses  terminate  in  the 
cortex  of  the  cerebruvi.  The  voluntary  motor  fibres  (psycho- 
motor or  cortico-muscular  tracts,  or  simply  pyramidal 
tracts)  course  from  the  cortex,  through  the  pons  Varolii  to 
the  anterior  pyramids  of  the  medulla  oblongata.  Here  most  of 
these  fibres  cross  over  to  the  opposite  side  (motor  decussation) 
and  go  to  the  motor  nerves  of  the  extremities,  through  the  lateral 
columns  of  the  spinal  cord.  A  few  fibres  that  do  not  decussate 
as  above  described  course  along  the  anterior  columns  of  the  spinal 
cord  and  gradually  pass  over  to  the  other  side  like  the  rest,  but 
through  the  white  commissure  along  the  course  of  the  cord. 

Hence  destructi\'e  processes  in  one  hem- 
isphere result  in  motor  and  s  e  n  s  o  r  3-  p  a  r  a  1  y  - 
sis     on     the     opposite     side     of     the     body. 

The  cerebral  hemispheres  are  also  the  seat  of  all  psychical  ac- 
tivities; they  are  the  seat  of  thought,  volition  and  sensation.  Many 
motor  centers  are  also  found  in  the  cerebral  cortex  and 
hence  inflammatory  conditions  of  this  region  may  be  attended  with 
convulsive  movements  of  the  muscles. 

The  midbrain  (crura  cerebri,  corpora  quadrigemini  and  optic 
thalami)  is  the  seat  of  the  entire  mechanism,  harmony  and  equilib- 
rium of  all  motions.  Animals  with  both  hemispheres  removed, 
but  with  the  midbrain  intact  can  retain  their  equilibrium  under  the 
most  varied  conditions.  Inflammatory  irritation  of  the  midbrain 
produces  involuntary  movements. 

The  cerebellum  harmonizes  or  co-ordinates  the  movements  of 
the  body  by  regulating  the  succession  of  muscular  contractions. 

The  spinal  cord,  besides  conducting  impulses  to  and  from  the 
brain,  contains  reflex  centers  which,  when  stimulated  by  afferent 
impulses,  cause  certain  kinds  of  important  movements  (defense, 
flight,  etc).  These  movements  are  carried  out  independent  of  any 
action  on  part  of  the  brain,  as  is  easily  proved  on  decapitated  ani- 
inals  or  where  the  spinal  cord  has  been  cut  through.  The  thus- 
isolated  cord  is  as  prompt  as  ever  in  producing  reflex  actions.  The 
lumbar  cord  is  the  special  center  for  defecation  and  urination,. 
which  also  depend  on  reflex. activity. 

To  be  able  to  recognize  normal  conditions  as  well  as  to 

determine  the  presence  and  seat  of  pathological  changes  in 

the  central  nervous  system,  observe  the  following  points : 


NERVOUS    SYSTEM,  199 

I.     Psychic      Functions. 
II.     Sensibility. 
III.     Motility. 

I.     Psychic  Functions. 

Since  the  cerebrum  and  particularly  its  cortex  is  the  seat 
of  all  psychic  activities,  disease  of  the  same  must  interfere 
with  normal  tliouf^ht,  feeling,  and  volition;  movements,  sen- 
sations and  perceptions  of  peripheral  parts  occur  unconscious- 
ly. The  general  mechanism,  harmony  and  equilibrium  of 
muscular  movements  may  be  entirel\'  intact  in  this  condition. 
JMental  disturbances  occur  in  a  great  many  infectious  dis- 
eases, in  febrile  diseases  in  general,  in  the  course  of  intoxica- 
tions (poisonings)  of  varied  kinds,  and  in  local  diseases  of 
the  brain  itself. 

Therefore,  mental  disturbances  can 
be  ascribed  to  local  causes  only  when 
the  possibilit}-  of  a  general  cause  i  s 
eliminated.  The  disturbances  in  question  consist  of 
abnormal  excitability  or  of  abnormal  depression. 

Mental  excitement  is  the  result  of  cerebral  ir- 
ritation —  as  observed  in  acute  cerebritis.  Horses  become 
restless,  neigh,  refuse  to  be  led,  try  to  tear  loose  from  the 
halter,  step  to  and  fro,  paw,  climb  up  into  the  manger,  are 
anxious  and  easily  frightened.  Cattle  bellow,  snort,  shake 
their  heads,  jump  around,  and  into  the  manger.  Dogs  mani- 
fest their  restlessness  by  an  aimless  running  about,  barking, 
howling  and  even  biting.  Pigs  squeal,  crawl  under  the  litter, 
run  about,  climb  over  obstacles  and  jump  up  against  walls. 
Similar  symptoms  are  also  observed  in  rabies,  acute  tubercu- 
lar meningitis,  malignant  catarrhal  fever  of  the  ox  and  in 
anthrax. 

Symptoms  of  mental  depression  frequent- 
ly follow  those  of  excitement.  The  animals  droop  the  head, 
rest  it  on  the  crib  or  feeding  rack,  eyes  half  closed,  take  no 


200 


CLINICAL    DIAGNOSTICS. 


interest  in  their  surrounding?,  do  not  rccog^nize  familiar  per- 
sons, run  against  obptacles,  etc.  In  feeding-  they  grab  the  food 
with  the  incisor  teeth,  chew  slowly  and  "languidly,"  stop 
without  a  motive  when  food  is  still  in  the  mouth  and  between 
the  lips.  In  drinking  they  plunge  their  mouth  into  the  water 
and  often  "chew"  it.  It  is  hard  to  make  theni  move,  they 
step  around  clumsily,  won't  "get  over"  when  commanded  to 


Fig:.  51. 


Horse  with  chronic  hydrocephalus. 


do  so;  they  are  hard  to  guide  when  driven,  try  "to  stay  over 
on  one  side ;  if  badly  affected  they  cannot  be  used  for  serv- 
ice because  they  do  not  recognize  commands.  According  to 
the  degree  of  mental  depression  we  recognize : 

Dullness  : 

Soiiuiolciicy,  slccl-'iiicss,  dro'icsiiicss,  from  which  the  pa- 
tient is  easily  roused. 

Sopor,  profound  sleep,  rousing  difficult. 

Coma,  profound  insensibilit}-. 

A    dulling    of  the  psychic  functions  occurs  in ; 


NERVOUS    SYSTEM.  201 

1.  All  acute  infectious  diseases ;  contagious  pleuropneu- 
monia, influenza,  Rinderpest,  anthrax,  horse,  distemper,  dog 
-distemper,  septicemia,  Rothlauf  of  swine,  etc. 

2.  All  severe  febrile  diseases. 

3.  Chronic  affections  of  the  brain :  blind  staggers,  turn- 
sick  of  sheep,  second  stage  of  acute  cerebritis  and  cerebral 
hyperemia. 

4.  Poisoning  with  narcotics. 

5.  Icterus,  uraemia. 

C).     Chronic  gastric  and  intestinal  affections  of  the  horse. 

Dizziness  (vertigo)  and  syncope  (fainting)  are  sud- 
denly occurring  t  e  m  p  o  r  a  r  y  disturbances  of  conscious- 
ness and  loss  of  equilibrium.  Animals  suddenly  become  un- 
steady in  gait  or  standing  position,  sway,  reel,  stagger  and 
sometimes  fall  to  the  ground.  The  cause  may  consist  of  the 
presence  of  parasites  in  the  brain,  hemorrhages,  tumors,  ab- 
scesses, passive  cerebral  hyperemia  (compression  of  jugulars 
by  harness),  aortic  insufficiency  or  stenosis,  also  the  action 
of  glaring  light  ("ocular  vertigo"),  irritations  of  the  external 
auditory  meatus,  and  of  the  nasal  mucous  membrane  by  para- 
sites, finally  also  of  poisoning  with  certain  plants. 

II.     Sensibility. 

The  sensibility  is  tested  by  artificial  stimulation,  sticking 
:a  finger  into  the  ear,  flipping  the  nose  with  the  finger,  stepping 
on  the  coronet,  pin  pricks.  In  testing  the  general  sensibility 
observe  that  no  inflammatory  condition  exists  in  the  part 
"tested."  Peripheral  irritation  may  give  rise  to  spinal  reflex 
actions,  e.  g.  the  hoof  may  be  raised  without  any  conscious- 
ness of  the  act  on  part  of  the  animal  either  as  to  the  act  or 
stimulus  producing  it.  For  this  reason  the  gen- 
eral behavior  of  the  whole  animal  must 
be  taken  into  account  in  testing  its 
sensibility.  If  dogs  cry  out  during  such  an  examination, 
■or    test    we  may  conclude  that  conscious  feeling  exists. 


202  CLINICAL    DIAGNOSTICS. 

Decreased  sensibility  is  called  hypesthesia,  absence  of 
sensibility  is  called  anesthesia,  abnormally  increased  sensibil- 
ity is  called  hyperesthesia.  Sometimes  sensibility  is  retarded; 
this  is  indicated  when  the  reaction  occurs  an  unusually  long 
time  after  the  stimulus  is  applied. 

Hyperesthesia  is  most  frequently  seen  in  old 
ticklish  mares,  also  in  lumbar  prurigo  of  sheep  and  in 
the  first  stages  of  cerebritis. 

Diminished  sensibility  is  observed  in  chronic  aflfections  of 
the  brain,  immobility,  tumors,  second  stage  of  acute  cerebritis, 
parturient  fever,  second  stage  of  cerebro-spinal  meningitis,  and 
in  narcotic  poisonings. 

III.     Motility. 

In  morbid  conditions  affecting  the  cerebral  hemispheres 
only  we  observe  no  serious  disturbances  in  motility  because  the 
mid  brain  and  the  cerebellum  are  the  seat  of  co-ordinated 
movements. 

a.  Spasms,  or  cramps,  are  involuntary  muscular  con- 
tractions. Spasms  of  short  duration,  alternating  with  relaxa- 
tions, are  called  clonic  spasms;  if  they  are  very  slight,  uni- 
form, rapid,  and  locally  limited  we  call  it  trembling;  if  they 
affect  large  areas  or  extend  over  the  whole  body  we  call  them 
convulsions.  Clonic  spasms  are  observed  in  partial  and  gen- 
eral epilepsy  and  in  inflammatory  affections  of  the  brain  and 
spinal  cord  (common  after  dog  distemper).  Tonic  or  tetanic 
spasms  are  muscular  contractions  that  continue  for  some  time 
without  relaxation.  They  are  characteristic  for  tetanus  (lock- 
jaw) and  strychnine  poisoning,  causing  the  body  to  assume 
a  stiff  position,  especially  the  head,  neck,  ears,  back,  and  tail. 
The  mouth  is  closed  as  a  result  of  contraction  of  masseter 
muscles,  nostrils  distended  "trumpet  like."  Stiffness  of  the 
back  without  bending  is  called  orthotonus,  depression  of 
spinal  column  and  bending  back  of  head  toward  withers,  opis- 
thotonus, spasms  of  the  masseter  muscles,  trismus,  spasms  o£ 


NERVOUS    SYSTEM.  203^ 

the  extensors  of  the  hmb.  satvhorsc  attitude,  muscles  o'f  the 
eye,  prolapsus  of  the  uicmbrana  ni'ctitans,  cramps  of  facial 
muscles,  risus  sardonicus  (canine  laugh).  Tonic  spasms  in 
connection  with  clonic  spasms  are  also  observed  in  cerebro- 
spinal meningitis  {cramp  of  the  neck). 

All  spasms  have  their  origin  in  the  cortex  of  the  cerebrum, 
the  pyramidal  tracts,  or  in  the  anterior  cornua  of  the  spinal 
cord.  Spasms  originating  in  the  cerebrum  are  attended  with 
mental  disturbances  (epilepsy),  not  so  in  case  of  spinal 
spasms. 

Rcflc.v  spasms  are  due  to  irritation  of  peripheral  sensory 
nerve  endings  and  are  of  spinal  origin ;  they  are  observed 
when  animal  parasites  occur  in  the  intestines,  during  the  pe- 
riod of  shedding  teeth,  and  in  painful  gastric  and  intestinal 
afifections. 

b.  Involuntary  movements  may  be  due  to  irritation 
of  one  of  the  cerebral  hemispheres  or  to  paralysis  of  the  op- 
posite one,  also  to  affections  of  the  midbrain  or  of  the  cere- 
bellum. They  always  proceed  from  circumscribed  lesions  and 
are  therefore  known  as  "symptoms  of  local  origin."  Some- 
times involuntary  movements  occur  in  the  muscles  of  the  body 
and  extremities,  or  the  usual  voluntary  movements  assume  an 
involuntary  character.  In  such  cases  animals  manifest  a 
desire  to  "go  ahead,"  trot  with  head  raised  or  lowered,  run 
against  obstacles  ;  if  they  get  into  a  corner  they  are  at  a  loss 
as  to  how  to  get  out,  frequentl}'  they  fall  down  in  such  cases. 
Sometimes,  but  more  rarely,  they  zvalk  backzcards.  If  the 
cerebral  disturbances  are  unilateral  the  symptoms  tend  to  be 
the  same.  The  animals  walk  in  a  circle  {Reitbahnhezve gun- 
gen,  riding  school  movements:)  they  lie  down  and  roll,  turn- 
ing on  their  long  axis,  or  they  fix  their  hind  feet  as  a  pivot, 
and  walk  aroimd  with  their  forefeet  —  move  like  the  hands 
of  a  clock.  Involuntary  movements  are  most  frequently  ob- 
served in  chronic  and  acute  hydrocephalus,  abscesses,  hem- 
orrhages, tumors  and  parasites  in  the  brain.  Turn  sickness,, 
[gid] ,'  of  sheep  is  thus  characterized. 


■5^04  CLINICAL    DIAGNOSTICS. 

In  so  called  riding  school  and  clock  hand  move- 
ment the  coenurns  is  usually  located  on  the  surface  of  that  half 
of  the  cerebral  hemispheric  facing  the  center  of  the  circle:  some- 
times on  the  optic  thalamus  of  the  opposite  side. 

If  aflFected  sheep  move  forward  with  the  head  down  and  trot- 
ting motion  of  the  forelimbs  (trotters)  the  seat  of  the  parasite 
is  at  the  anterior  end  of  the  hemisphere  or  on  one  of  the  corpora 
striata. 

Staggering  gait,  reeling,  dizziness  (staggerers)  indicate  that 
the  parasite  is  located  in  or  on  the   cerebellum. 

When  the  coenurus  is  located- at  the  base  of  the  cerebellum  it 
causes   rolling  movements   of   the   animal. 

If  the  animals  hold  their  heads  up  high  or  backwards  and 
move  forward  rapidly,  fall  down  (sailors),  the  coenurus  is  located 
in  the  posterior  portion  of  the  cerebrum. 

c.  Disturbances  of  the  muscular  sense.  The  muscu- 
lar sense  enables  us  to  recognize  the  position  of  the  limbs  and 
the  extent  of  passive  and  active  movements.  As  long  as  equi- 
librium is  not  affected,  an  animal  suft'ering-  from  disease  of 
the  cerebrum  can  be  made  to  assume  unphysiologic  positions 
without  being  conscious  of  it,  in  fact  they  do  this  themselves, 
they  interrupt  movements  before  they  are  completed  or  go 
to  the  opposite  extreme'  and  make  more  extensive  move- 
ments than  occur  normally. 

In  acute  cerebritis  and  staggers  horses  sometimes  assume 
peculiar  positions  of  the  legs,  cross  them,  set  them  close  to- 
gether or  one  before  the  other :  one  may  be  set  unduly  forward, 
the  other  unduly  under  the  body.  \A'hen  such  positions  are 
produced  passively  the  animals  luake  no  attempts  to  change 
them.  In  moving  about  they  raise  their  legs  unusualh-  high, 
(groping,  wading  walk)  or  not  high  enough  and  thus  stumble 
when  they  meet  obstacles. 

d.  Paralyses  consist  in  partial  or  complete  loss  of 
power  to  bring  about  muscular  contractions.  Complete  in- 
ability to  move  is  called  complete  paralysis ;  if  there  is  simply 
diminished  power  to  produce  movements  we  call  it 
incomplete  paralysis  (paresis).  According  to  the  origin  of 
the  paralysis  we  distinguish  cerebral,  spinal,  and  peripheral 
paralyses.     Paralysis  of  one  side  of  the  bodv  is  called  hemi- 


NERVOUS    SYSTEM.  205 

plcgia,  of  both  sides  (both  hind  legs)  paraplegia;  paralysis  of 
a  single  organ  or  part  is  known  as  monoplegia.  Hemiplegia 
has  its  origin  in  the  brain,  paraplegia  in  the  spinal  cord, 
monoplegia  in  the  motor  centers  of  the  brain  or,  and  as  a 
rule,  in  peripheral  nerves.' 

In  cerebral  paralyses  the  cranial  nerves  are 
frequently  also  affected  and  psychic  disturbances  are  present; 
we  observe  cerebral  paralysis  in 

1.  Brain  diseases:  acute  cerebritis,  cerebro-spinal  menin- 
gitis, abscesses,  hemorrhages   (apoplexies),  tumors,  parasites. 

2.  Infectious  diseases:  rabies,  mal  du  coit  (always),  ex- 
ceptionally in  horse  distemper,  and  in  contagious  pleuro-pneu- 
monia  of  the  horse. 

3.  In  intoxication  diseases:  parturient  fever,  mycotic 
intoxications,  brine  poisoning. 

Spinal  paralyses  are  usually  cases  of  paraplegia 
which  aft"ect  all  nerves  beyond  the  point  of  injury  or  dis- 
ease and  are  always  attended  with  sensory  paralysis. 
Psychic  disturbances  are  wanting.    They  are  caused  by : 

1.  Spinal  fractures; 

2.  Diseases  of  the  cord:  inflammation,  hemorrhage,  tu- 
mors, parasites ; 

3.  Infectious  diseases:  dog  distemper,  rabies,  rarely  in 
contagious  pleuro-pneumonia  of  the  horse. 

Spinal  paralyses  also  affect  the  veg- 
etative branch  of  the  nervous  s  }-  s  t  e  m  , 
since  the  lumbar  cord  is  the  center  for  the  production  of  the 
contractions  that  produce  defecation  and  urination.  Hence 
paralysis  of  the  rectum  and  bladder  with  the  inevitable  results 
(impaction  of  rectum  and  distention  of  bladder  with  urine) 
occurs.     See  pp.  137  and  148. 

Peripheral  paralyses  are  for  the  most  part  of 
surgical  interest.  In  internal  medicine  paralysis  of  the  fa- 
cial nerve,  because  it  interrupts  normal  feeding,  and  paralysis 
of  the  recurrent  nerve,  because  it  disturbs  respiration,  are  of 


206  CLINICAL    DIAGNOSTICS. 

interest.     These  two  morbid  conditions  have  been  considered 
more  in  detail  elsewhere. 

e.  Reflex  excitability.  Reflex  movement  is  a  tem- 
porar\-  muscular  contraction  brought  about  by  stimulating  a 
peripheral  (sensory)  nerve  ending.  In  order  that  reflex  move- 
ment may  occur  the  sensory  and  motor  nerve  fibres  and  the 
reflex  center  must  be  intact.  Reflex  movement  is  limited  to  one 
muscle  or  muscle  group  (simple  reflex)  or  it  may  affect  the 
whole  body  and  in  that  case  may  be  iiico-ordinated  {reflex 
spasm)  or  co-ordinated  {uiotions  of  defense  or  Hii:^hf).  The 
following  physiological  reflexes  are  of  clinical  importance : 

a.     Reflexes  of  the  Brain. 

1.  Closing  of  the  eyelids.  The  sensory 
fibres  (trigeminus)  of  the  cornea,  conjunctiva  and  of  the  skin 
in  the  neighborhood  of  the  eye  conduct  impulses  to  the  medulla 
oblongata  and  from  that  point  the  facial  nerve  produces  con- 
traction of  the  orbicularis  of  the  eyelids. 

2.  Sensitiveness  to  light  on  j)  a  r  t  of 
the  pupil.  Increased  reflex  excitability 
occurs  in  tetanus  and  in  strychnine  poisoning.  Contracted 
pupil  is  observed  in  morphine,  eserine  and  pilocarpine  poison- 
ing. 

Decreased  reflex  excitability  in  great 
mental  depression,  excessive  pain  and  in  dyspnoea  of  high 
■degree. 

Dilated  pupil  (tnydriasis)  occurs  in  paralysis  of 
the  optic  nerve  (black  cataract)  and  in  paralysis  of  the  oculo 
motor  nerve   (atropin  poisoning). 

b.     Spinal  Reflexes. 

1.  Skin  reflexes  consist  of  muscular  contractions  fol- 
lowing irritation  of  sensory  peripheral  nerves,  e.  g.  manipu- 
lation or  percussion  of  the  walls  of  the  chest  or  the  flank. 
Touching  the   anus   causes   contraction   of   the   sphincter   ani 


NERVOUS   SYSTEM.  207 

(anal  reflex)  ;  touching  the  skin  at  the  perineum  results  in 
drawing  up  of  the  tail  and  depression  of  the  croup. 

2.  Mucous  membrane  reflexes.  Pressure  upon  the 
larynx  or  the  upper  rings  of  the  trachea  produces  a  cough 
(laryngeal  reflex). 

3.  Tendon  reflexes.  Striking  the  flexor  tendons  of 
the  carpus,  the  inferior  patellar  ligaments  or  the  achilles  ten- 
don causes  the  animal  to  raise  its  legs. 

4.  Normal  defecation  and  urination. 

Spinal  reflexes  are  diminished  or  absent  in  disturbances 
of  the  reflex  arc,  hence  in  peripheral  paralyses  and  diseases 
of  the  spinal  cord.  Increased  reflexes  are  observed  in  hyper- 
esthesia, strychnine  poisoning  and  in  diseases  of  the  reflex 
inhibitory  centers  of  the  brain. 

Diseases  of  the  Nervous  System. 

Cerebral  congestion.  Hyperemia  of  short  duration,  fluctuat- 
ing in  character  and  entirely  curable.  Begins  with  stage  of  ex- 
citement; animals  are  restless,  try  to  force  themselves  forward  or 
sideways,  rear,  kick,  shake  their  heads,  walk  backwards,  tear  the 
halter  strap,  etc.  After  a  few  hours  the  stage  of  depression  sets 
in:  animals  are  stupefied,  sad  look  of  the  eye,  head  down,  disregard 
familiar  commands. 

Acute  inflammation  of  the  brain,  acute  hydrocephalus.  Differs 
from  congestion  in  its  more  pronounced  symptoms  and  its  longer 
duration.  In  the  second  stage  (that  of  depression)  we  observe 
abnormal  attitudes  and  movements,  staggering,  sometimes  falling 
down  and  inability  to  get  up  again,  sometimes  attacks  of  raving 
madness.  Temperature  frequently  increased,  but  fever  may  be 
absent.  Feeding  always  more  or  less  interrupted,  especially  the 
manner  of  feeding. 

Blind  staggers.  Morosis  equorum.  Hydrocephalus  chronicus. 
This  is  a  chronic  apyretic  incurable  affection  of  the  cerebrum  which 
manifests  itself  by  mental  disturbances,  and  by  impaired  locomo- 
tion and  sensibility.  Pulse  strong  and  full,  number  of  heart  beats 
never  increased,  but  frequently  diminished — a  very  constant  symp- 
tom. Appetite  usually  good  but  animal  eats  slowly.  Ability 
to  work  present  to  a  limited  degree.  Examination  for  staggers. 
See    p.    180. 

Epilepsy,  "Falling  sickness"  is  a  chronic  disease  of  the  brain 
characterized  by  paroxysms  occurring  at  intervals  and  attended 
by  sudden  loss  of  consciousness  and  disturbed  sensibility. 

Dizziness,    vertigo.      This    is    a    primary    disease,'  occurring    at 


208  CLINICAL    DIAGNOSTICS. 

intervals,  characterized  by  interrupted  equilibrium  and  due  to  cir- 
culatory  disturbances   in   the   brain. 

Cerebral  hemorrhage.  Apoplexj'.  Sudden  dizziness,  involun- 
tary movements,  loss  of  consciousness,  falling  down,  paralysis 
(hemiplegia   and   monoplegia). 

Eclampsia  is  an  acute  epilepsy,  ending  in  recovery  or  in  death. 

Turnsick  is  a  disease  of  sheep  caused  by  the  presence  of  the 
larval  form  of  Tenia  coenurus  in  the  brain..  1st  stage,  cerebral 
excitement;  2nd  stage,  latent  stage;  3rd  stage  is  that  of  turnsick, 
characterized   by   sj-mptoms   of   local   brain   affections. 

Paralysis  of  the  facial  nerve.  In  case  of  peripheral  paralysis 
the  cheeks,  lips  and  nasal  muscles  are  paralyzed,  usually  unilater- 
ally; if  paralysis  is  bilateral  we  have  dj'spnea  and  difficult}'  in 
feeding.  In  case  of  central  paralysis  the  upper  eyelids  droop, 
eyes  cannot  be  closed  and  the  auricular  muscles  are  affected. 

Lumbar  prurigo  of  sheep  is  a  chronic,  hereditary  affection  of 
the  spinal  cord  characterized  by  hyperesthesia,  weakness  and 
paralysis  of  the  hind  parts  and  by  progressive  emaciation,  invaria- 
bly leads  to  death. 

Infectious     Diseases     with     Localization     in 
the     Central     Nervous     System. 

Tetanus  is  an  intoxication  produced  by  the  entrance 
of  the  products  of  the  tetanus  bacilli  into  the  blood.  Spasmodic 
condition  of  the  entire  skeletal  muscles,  animal  is  stiff,  ej-es  re- 
tracted, membrana  nictitans  prolapsed,  head  and  neck  bent  back, 
back  depressed,  tail  erect.  Sawhorse  attitude  of  legs,  hock  turned 
out,  producing  bowleggedness.  Spasm  of  masseter  and  pharyngeal 
muscles  interfere  with  mastication  and  deglutition,  spasm  of  the 
respiratory  muscles  affects  respiration.  Great  excitability;  thus 
aggravating  the  general  muscular  cramps.  At  first  no  fever,  later 
on  the  fever  is  high.  Pulse  strong  and  full.  Animals  do  not  lie 
down,  or  when  down  they  cannot  get  up.  Mental  condition  is 
normal. 

Rabies  is  a  strictly  infectious  disease  characterized  by  disturb- 
ance of  the  central  nervous  system.  1.  Initial  stage.  Dogs 
are  restless,  moody,  easily  frightened,  want  to  be  out  of  doors, 
depraved  appetite.  2.  Raving  stage.  Aimless  running  about, 
tendency  to  bite,  sometimes  break  their  own  teeth  in  the  act, 
voice  changed  to  a  barking  howl.  3.  Paralytic  stage. 
Emaciation,  lower  jaw  paralyzed,  tongue  extended,  hind  quarters 
paralyzed.  Horses  show  restlessness  as  in  colic,  neigh  in  a 
peculiar  shrill  or  yelling  manner,  try  to  gnaw  or  bite  the  point  of 
infection,  bite  the  manger  and  not  infrequently  fracture  the  lower 
jaw  in  the  act.  Paralysis  and  death  follow  within  three  days. 
Cattle  bellow  and  run  against  objects  with  their  horns,  frequently 
fracturing  them.     Sheep  and  pigs  also  manifest  a  desire  to  bite. 

Infectious  cerebro-spinal  meningitis.  Disease  is  frequently  in- 
troduced  with    chills.      Slight    fever.      Sensibility   reduced,   animals 


BODY    MOVEMENTS.  209 

are  drowsy,  stumble  and  fall  on  slight  provocation.  Turning  of 
eyes,  jerking  of  muscles,  later  on  paralysis.  Tonic  spasms  of  the 
cervical  muscles;  head  drawn  to  one  side. 

Intoxication  Diseases. 
Parturient  paresis,  milk  fever,  is  an  acute  auto-intoxication 
closelj^  following  the  act  of  parturition,  and  characterized  bj^  cere- 
bral paralysis.  Begins  with  slight,  temporary,  cerebral  excitement; 
after  a  few  hours  symptoms  of  depression  and  paralysis  set  in. 
Animals  lie  immovably  in  a  characteristic  attitude,  see  p.  34.  Eyes 
closed,  paralysis  of  muscles  of  head,  tongue  extended,  rattling 
breathing,  distention  of  abdomen,  constipation,  paresis  of  paunch. 
Lowering  of  external  and   internal  bodily   temperature. 

C.     Specific  Examinations. 

We  resort  to  the  specific  examinations  only  when  definite 
results  cannot  be  obtained  with  the  foregoing  methods,  espe- 
cially in  cases  of  differential  diagnosis  between  similar  dis- 
eases. In  al  cases  the  specific  examina- 
tions are  directed  toward  determining 
definite  diseases;  and  the  characteris- 
tics     of     these     are     specially     considered. 

12.     Body  Movements. 

]\Iany  diseases  are  not  observed  tmtil  the  animal  is  in 
harness  or  under  the  saddle,  others  become  more  conspicuous 
in  their  symptoms  under  these  conditions.  The  rule  is  to 
examine  animals  while  engaged  in  their  accustomed  occupa- 
tion (blind  staggers,  balkiness).  Draft  horses  should  be  ex- 
amined when  hitched  to  the  wagon,  riding  horses  under  their 
rider.  Unaccustomed  work  fatigues  animals  unduly  and  ex- 
cites them.  Sometimes  fatigue  and  excitement  make  certain 
symptoms  more  conspicuous  (roaring)  ;  in  such  cases  we  make 
an  exception  of  the  rule  just  given.  In  all  cases  we  must  ob- 
serve that  the  animal  is     properly     harnessed. 

I.     Examination  for  Immobility. 

(Examination  of  So-called  Dummies). 

Blind  Staggers. 
Blind  staggers  may  be  defined  as  an  incurable  disease  of 
the  brain  accompanied  by  cerebral  depression.     It  may  develop 


210  CLINICAL   DIAGNOSTICS. 

gradually  or  follow  an  attack  of  acute  hydrocephalus.  Ac- 
cordingly, blind  staggers  is  characterized  by  disturbances  of 
consciousness.  These  symptoms  may  be  observed  while  the 
animal  is  at  rest,  but  frequently  they  are  not  sufficiently  pro- 
nounced so  that  a  diagnosis  can  be  based  upon  them.  Sub- 
jecting a  suspicious  animal  to  exercise  is  a  valuable  aid  in 
making  a  diagnosis,  it  furnishes  a  better  opportunity  for  test- 
ing the  psychic  functions  and  the  resulting  increased  blood 
pressure  intensifies  the  existing  symptoms. 

It  is  of  diagnostic  importance  that  horses  affected  with 
immobility  can  be  used  for  work,  though  in  a  limited  degree, 
and  that  horses  suffering  with  acute  cerebral  affections  re- 
fuse to  work  or.  if  worked,  symptoms  of  cerebral 
excitement  follow.  Again,  horses  with  blind  stag- 
gers always  have  a  low  pulse,  eat  s  1  o  w  1  y  but  nevertheless 
eat  a  full  feed.  On  the  other  hand,  horses  with  acute 
cerebral  affections  have  poor  appetite  and  a  high,  or  change- 
able, pulse. 

In  examining  for  blind  staggers  the  horses  must  be  test- 
ed while  performing  accustomed  duties,  and  care  must  be  ob- 
served not  to  excite  them ;  in  no  case  must  they  be  subjected 
to  unaccustomed  work.  It  is  advisable  to  drive  or  ride  the 
animal  oneself ;  notice  the  facility  with  which  the  animal  is 
guided,  effect  of  whip  and  spurs,  tendency  to  go  over  to  one 
side,  ease  with  which  animal  moves  forward  or  backward.  As 
soon  as  the  animal  begins  to  sweat  it  is  taken  to  a 
quiet  place  and  rested,  here  we  repeat  a  careful  examination 
of  the  cerebral  functions,  (the  animal's  psychical 
condition)  ;  observe  the  expression  of  the  eye,  effect  of  sur- 
roundings, general  attitude  of  the  body,  movements  of  the 
head,  use  of  eyes  and  ears.  To  determine  the  degree  of  sen- 
sibility we  resort  to  mechanical  irritation :  gently  inserting  a 
finger  into  the  animal's  ear,  flipping  the  finger  against  the  nose, 
stepping  on  the  coronet,  kicking  against  the  cannon  bone. 
Finally  the  animal's  motility  is  tested  to  determine  whether  it 


BODY    MOVEMENTS. 


211 


voluntarily  assumes  unnatural  positions  (setting  a  foot  ab- 
normally forward  or  back)  whether  it  advances  or  backs  read- 
.ily,  follows  its  leader  or  not,  halts  without  a  command  when 
the  attendant  leading  it  stops,  etc.      An  important  test  is  to 


Fig.  52. 


Examination  of  a  horse  for  Blind  Staggers. 


attempt  to  cross  the  forelegs;  horses  with  blind  staggers  can 
usually  be  made  to  assume  this  position  and  throw  their  weight 
on  their  feet  when  thus  crossed.  To  make  this  test  the 
operator  stands  on  one  side  of  the  animal.  hi.s_  legs  spread  so 


\ 

212  CLINICAL  DIAGNOSTICS. 

that  one  is  in  front,  and  the  other  behind  the  front  leg  of  the 
horse,  then  grasps  the  foot  of  the  opposite  side  (at  the  meta- 
carpus and  from  behind),  forces  the  horse  back  a  Httle  to 
relieve  the  foot  in  question,  pulls  it  over  and  crosses  it  in 
front  of  its  opposite. 

Quiet  and  gentle  animals  will  sometimes  remain  standing 
in  this  position  and  even  permit  other  insults,  but  from  their 
general  attitude  it  is  plain  that  the  reason  for  all  this  is  not 
an  abnormal  mental  state  but  rather  extreme  good  naturedness. 
Animals  greatly  fatigued  may  show  symptoms  of  a  depressed 
sensorium,  but  they  are  always  of  short  duration. 

A  single  symptom  can  never  deter- 
mine a  diagnosis,  we  must  consider  the 
animal's   condition  as  a   whole. 

II.     Examination   for   Heaves. 

Heaves  may  be  defined  as  a  chronic,  incurable  disease  of 
the  lungs  or  of  the  heart,  characterized  by  difficult  and  la- 
borious respiration. 

This  definition  is  forensic  in  its  sense,  and  includes  a 
number  of  chronic  incurable  diseases  of  the  lungs  and  of  the 
heart  that  are  attended  with  difficult  respiration.  As  a  rule 
chronic  bronchitis,  alveolar  emphysema  of  the  lungs,  chronic 
interstitial  pneumonia  or  heart  disease  constitute  the  anatom- 
ical lesion  at  the  bottom  of  heaves.  Although  it  is  frequently 
possible  to  determine  the  exact  nature  of  the  anatomical  le- 
sion, it  is  customary,  in  Germany  at  least,  to  apply  the  term 
"heaves"  to  all  of  these  conditions,  because  "heaves"  is  con- 
sidered as  one  of  those  diseases  the  presence  of  which  is  a 
legal  ground  for  the  setting  aside  of  a  contract  of  sale  and  is 
referred  to  under  this  name  in  all  laws  concerning  it. 

The  term  "difficult  and  laborious  respiration"  is  com- 
parative in  its  sense,  and  in  applying  it  we  must  always  con- 


BODY    MOVEMENTS.  213 

sider  the  nature  of  the  exercise  leading  to  it  as  Avell  as  the 
constitution  and  anatomical  make-up  of  the  animal.  On  tlie 
other  hand,  whether  the  pathological  condition  in  any  way 
affects  the  use  of  the  animal  for  some  particular  purpose  or 
not,  does  not  come  under  consideration.  To  make  a  positive 
diagnosis  of  "heaves"  it  is  necessary  only  to  recognize  the 
existence  of  a  difficulty  of  respiration  which  is  due  to  a  chronic 
and  incurable  disease  of  the  lungs  or  of  the  heart. 

For  this  purpose  a  careful  examination  of  the  circula- 
tory apparatus  and  of  the  respiratory  apparatus  is  indispens- 
able. It  is  also  necessary  to  determine  positive  symptoms  of 
the  disordei;^  under  consideration  in  order  to  be  fortified 
against  the  possible  assertion  that  the  disease  is  due  to  other 
causes  than  chronic  and  incurable  affections  of  the  lungs  or  of 
the  heart.  Furthermore,  we  must  exclude,  by  careful  exam- 
ination of  all  functional  apparatus,  any  acute  affections  that 
may  produce  increased  respiration.  External  painful  condi- 
tions must  also  be  taken  into  consideration. 

If  it  is  impossible  to  differentiate  between  the  effects  of  dis- 
turbances of  this  nature  and  existing  symptoms  of  heaves,  it 
would  be  well,  in  all  cases  where  legal  complications  are  possible, 
to  inform  both  buyer  and  seller  of  the  existing  conditions  and  of 
the_  necessity  of  withholding  the  expression  of  a  final  opinion 
until  the  animal  has  recovered  from  the  existing  acute  disease. 
If,  at  such  a  time,  the  previously  observed  symptoms  of  "heaves" 
are  still  present,  the  existence  of  the  disease  at  the  time  of  pur- 
chase   must    be    conceded. 

The  examination  of  a  suspected  "heavey"  horse  is  con- 
ducted not  only  while  the  animal  is  at  rest,  but  also  during 
and  after  exercise.  Animals  are  worked  in  an  accustomed 
manner  and  made  to  exert  themselves  to  a  moderate  degree,  at 
the  same  time  we  note  the  character  and  frequency  of  respira- 
tion. The  horse  should  be  driven  or  ridden  in  a  quiet  trot ;  a 
draft  horse  made  to  pull  a  moderately  heavy  load.  Count  the 
respirations  every  5  minutes  and  let  the  animal  work  until  it 
sweats,  but  not  longer  than  15  minutes.  Then  put  the  animal 
in  a  stable,  count  the  respirations  every  5  minutes  and  note 


214  CLINICAL   DIAGNOSTICS. 

when  they  return  to  the  normal  (the  number  counted. before 
exercising). 

In  healthy  horses  the  number  of  respirations 
runs  as  high  as  50  or  TO  per  minute,  sometimes  even  higher. 
Respiration  occurs  without  exertion,  the  animals  may  now  and 
then  give  a  voluntary  snort  and  take  a  few  deep  inspirations. 
In  the  course  of  at  most  15  to  18  minutes  after  cessation  of 
the  exercise,  the  number  of  respirations  should  be  reduced  to 
that  observed  at  rest. 

"  H  e  a  v  e  y  "  horses,  on  the  other  hand,  show  increased 
or  difficult  brething,  dyspnea,  (see  p.  84).  Inspiration  and 
expiration  may  be  so  difficult  that  the  number  is  #ot  increased, 
but  the  character  of  the  respiratory  movements  enables  us  to 
recognize  the  dyspnea.  But  as  a  rule  the  number  of  res- 
pirations, when  animals  are  exercised  as  above  described,  runs 
up  to  80  to  120  per  minute  and  goes  back  to  the  normal  very 
gradually.  Not  infrequently  this  requires  30  to  GO  minutes. 
In  chronic  bronchitis  a  white  foamy  nasal  discharge  is  ob- 
served. 

III.     Examination  for  Roaring. 

The  term  "roaring"  is  applied  to  a  form  of  breathing 
attended  with  the  production  of  an  audible  sound  and  due  to 
a  chronic,  incurable  disease  of  the  larynx  or  trachea. 

As  a  rule,  roaring  is  caused  by  a  paralysis  of  the 
left  recurrent  nerve  and  the  resulting  inactivity  and  degener- 
ation of  the  muscles  which  it  supplies  (Hemiplegia  laryngis 
sinistra). 

In  rare  cases  a  paralysis  of  the  right  recurrent  nerve  or 
a  bilateral  paralysis  may  exist;  sometimes  thickening  of  the 
mucous  membrane  or  the  presence  of  tumors  may  be  the  cause. 
An  exact  diagnosis  of  the  cause  of  such  a  stenosis  can  be  defi- 
nitely determined  only  with  the  aid  of  the  laryngoscope ;  but 
in  99  per  cent,  of  all  cases  a  left  handed  paralysis  is  the  cause. 

Except  in  rare  cases,     laryngeal     roaring    is  no- 


CODY    MOVEMENTS.  215 

ticed  only  in  forcible  or  increased  respiration,  and  is  then 
characterized  by  a  harsh,  sharp  inspiratory 
noise  or  tone  ( wheezing,  whistling,  blowing,  hum- 
ming, roaring,  snoring.)  The  respiratory  noise  is  caused  by 
the  fact  that  deep  and  rapid  inspiration  causes  the  air  current 
to  force  the  paralyzed  arytenoid  cartilage  and  vocal  cord  into 
the  lumen  of  the  larynx  and  thus  obstructs  its  free  passage. 
Decreasing  the  volume  of  the  ingoing  current  of  air  by  com- 
pressing the  nostrils  causes  the  noise  to  cease.  Pressure  on 
the  paralyzed  arytenoid  cartilage  increases  the  noise.  Pres- 
sure on  the  right  (unaffected)  cartilage  increases  dyspnoea  to 
such  an  extent  that  inspiration  is  almost  impossible,  it  ceases 
entirely  or  continues  with  a  sharp  wheezing  sound,  because 
the  lumen  of  the  larynx  is  now  obstructed  by  both  arytenoid 
cartilages. 

In  examining  for  r  o  a  r  i  n  g  the  horse  must  be  placed 
under  conditions  that  force  it  to  make  rapid  and  energetic  respira- 
tory movements,  it  must  be  "worked  hard,"  pull  heavy  loads  over 
soft  ground,  or  gallop.  Exercising  or  riding  are  especially  adapted 
for  this  purpose  because  we  can  control  the  position  of  the- head, 
and  thus  influence  respiration.  Whether  or  not  the  animal  is 
accustomed  to  this  sort  of  exercise  has  no  effect  on  the  ffeneral 
result. 

If  the  head  and  neck  of  the  animal  are  well  checked  up  and 
back,  the  points  of  insertion  of  the  dorsal  muscles  are  approxi- 
mated and  the  action  of  the  latter  on  the  spinal  column  is  reduced: 
now.  in  order  to  fix  the  spinal  column  the  longissimus  dorsi,  the 
inspiratory  and  the  abdominal  muscles  must  be  contracted  with 
unusual  force;  this  can  be  done  only  at  the  moment  of  inspiration. 
In  expiration  these  muscles  are  relaxed  and  the  animal  loses,  more 
or  less,  the  control  over  its  spinal  column.  It  therefore  makes 
an  effort  to  reduce  the  expiratory  period  by  rapidly  and  energetic- 
ally following  with  the  inspiratory  movement.  If  only  one  aryte- 
noid cartilage  projects  over  the  lumen  of  the  larynx  the  inspiratory 
current  forces  it  in,  produces  a  stenosis  and  causes  the  respiratory 
sound.  By  turning  the  head  toward  the  right  the  in-streaming 
current  of  air  is  directed  on  the  left  arytenoid  cartilage,  and  if  the 
paralysis  is  only  an  incomplete  one  the  characteristic  sound  is  pro- 
duced just  the  same. 

This  kind  of  treatment  can  never  pro- 
duce   roaring    in      a    healthy    horse. 

In  order  to  make  a  positive  diagnosis  of  "roaring"  it 
is  necessary  to  eliminate  the  possible  presence  of  acute  morbid 


216  CLINICAL  DIAGNOSTICS. 

conditions  of  the  upper  air  passages  as  well  as  stenoses  of  the 
nasal  cavities  since  these  conditions  will  also  produce  audible 
breathing.  Contractions  or  other  deformities  of  the  nasal 
cavities  can  frequently  be  recognized  upon  superficial  exami- 
nation, or  by  the  wheezing  noise  they  produce.  If  the  trouble 
is  unilateral,  the  peculiar  noise  will  cease  upon  closing  the  af- 
fected side,  or  become  more  pronounced  upon  obstruction  of 
the  healthy  nostril. 

If  existing  lameness  or  the  presence  of  acute  affections  of 
the  respiratory  apparatus  or  other  organs  make  this  method 
of  examination  impossible,  the  laryngoscope  may  do  valuable 
service.     (See  p.  101.) 

IV,     Examination  for  Epilepsy  and  Vertigo. 

Epilepsy  is  a  chronic  cerebral  disease  that  is  char- 
acterized by  paroxysms  occurring  at  intervals  and  attended 
with  interruption  or  loss  of  consciousness  and  sensibility. 
Vertigo  (dizziness)  is  a  similar  affection;  it  is  an  inde- 
pendent disease  occurring  in  the  form  of  periodical  attacks, 
disturbed  equilibrium  and  consciousness.  The  difference  be- 
tween epilepsy  and  vertigo  is  that  spasms  are  absent  in  the 
latter. 

The  diagnosis  of  these  two  diseases  is  not  diffi- 
cult if  one  has  an  opportunity  to  observe  an  attack.  In  the 
intervals  horses  act  perfectly  normal. 
Sometimes  certain  known  conditions  bring  about  an  attack; 
when  making  an  examination  of  suspected  animals  we  can 
often  make  use  of  this  knowledge  to  bring  on  an  attack. 
Horses  may  be  hitched  up  and  driven  as  on  former  occasions 
when  an  attack  was  observed,  etc.  The  fit  of  the  harness 
should  be  carefully  inspected.  Sometimes  frightening  or  ex- 
citing the  animal,  or  driving  with  the  face  turned  toward  the 
setting  sun,  or  along  streets  sprinkled  with  alternating  shade 
of  trees  and  the  glaring  light  of  the  sun,  \vill  produce  an  at- 
tack. If  we  cannot  personally  observe  an 
attack  we  must  base  our  diagnosis  upon 
unobjectionable    statements    ofwitn  esses. 


BODY    MOVEMENTS.  217 

Epilepsy.  Characteristic  epileptic  spasms  occur  either  only  at 
the  head  and  neck  (partial  epilepsy)  or  the  whole  body  is  affected 
(general  epilepsy).  Animals  stop  suddenly,  distort  their  eyes, 
blink,  spasmodically  contract  the  muscles  of  the  lips  and  face, 
raise  their  heads  high  and  jerk  them  to  one  side,  sometimes  they 
step  to  and  fro,  or  backward  and  forward,  restlessly.  In  general 
epilepsy  the  spasms  rapidly  extend  over  the  whole  body;  mastica- 
tory movements  are  spasmodic,  the  saliva  is  churned  into  foam, 
the  animals  grate  their  teeth,  spasmodically  distort  their  neck  side- 
ways, the  muscles  generally  undergo  spasmodic  contractions,  the 
animals  stagger  and  fall  and  then  the  spasms  may  continue  for 
some  minutes.  An  attack  may  last  from  ^  to  15  minutes,  the 
horses  then  get  up  and  become  quieted.  The  intervals  between 
attacks   are   very  irregular. 

The  above  described  idiopathic  epilepsy  must  be  distinguished 
from  acute  cerebral  affections  and  from  epileptiform  spasms  due  to 
peripheral  irritations   (reflex  epilepsy). 

Vertigo.  Attacks  usually  occur  while  animals  are  at  work; 
they  suddenly  walk  slower,  nod  and  shake  their  heads,  snort,  raise 
their  heads  up  and  sideways,  stagger,  spread  their  legs  and  not 
infrequently  fall  down.  Here  they  lie  quietly,  sometimes  kick  a 
little  and  then  get  up  again.  During  the  attack  there  is  a  loss  of 
consciousness  and  sensibility,  sometimes  increased  respiration  and 
profuse   sweating. 

Attacks  of  dizziness  due  to  congestion  of  the  brain  (compres- 
sion of  the  jugulars)  and  to  cerebral  anemia  (stenosis  of  aortic 
valves)  do  not  belong  under  the  head  of  idiopathic  vertigo. 

V.     Examination  for  Balkiness. 

Balkiness  is  refractoriness  manifested  in  common  and 
accustomed  work.  Hence  a  horse  must  be  tested  while  at 
accustomed  work,  and  we  must  proceed  with  utmost  caution 
and  quiet  and  avoid  everything  that  might  excite  the  animal. 
The  examining  veterinarian  must  be  pres- 
ent during  all  manipulations  and  see  to  it 
that  rough  or  improper  treatment  is  avoided. 

We  first  examine  those  parts  of  the  body  that  bear  the 
weight  and  pressure  of  the  harness  and  see  that  no  morbid  or 
painful  conditions  exist ;  the  animal  is  then  properly  harnessed. 
In  case  the  harness  does  not  fit,  it  should  be  made  so  by  short- 
ening or  lengthening  parts  that  may  require  it,  or  by  using 
a  new  set  of  harness.  Then  the  animal  is  tested  in  the 
capacity  for  which  it  is  intended,  single  or  double,  as  coach 
or  draft  horse,  or  under  the  rider,  as  the  case  mav  be.    Active 


218  CLINICAL  DIAGNOSTICS. 

or  passive  refractoriness  to  reasonable  demands  is  regarded  as 
balkiness. 

Young  animals,  such  as  are  not  yet  sufficiently  accus- 
tomed to  work,  also  evince  a  certain  degree  of  refractoriness, 
but,  as  a  rule,  if  properly  handled  they  will  soon  yield  and 
obey  willingly,  especially  if  they  are  hitched  with  older  and 
quiet  horses. 

13.     Diagnostic  Inoculation, 

Diagnostic  inoculations  consist  in  the  introduction  of  cer- 
tain substances  into  the  bodies  of  animals  for  the  purpose  of 
determining  either  the  character  of  the  substance  or  the  con- 
dition of  the  animal's  health.  We  base  our  judgment  on  the 
character  of  the  result.  For  the  clinician  diagnostic  inocula- 
tions serve  merely  to  recognize  a  few  infectious  diseases ;  cer- 
tain of  these  diseases  have  so  rapid  a  course  that  the  clinical 
symptoms  cannot  be  relied  upon  to  determine  either  their  kind 
or  character  with  any  degree  of  certainty.  Others  which  ter- 
minate much  less  rapidly  do  not  show  sufficient  symptoms  for 
a  definite  diagnosis.  In  these  cases  nothing  save 
a  correctl}-  performed  inoculation  will 
serve  to  recognize  the  disease  or  to  ob- 
tain   an    early    diagnosis. 

Diagnostic  inoculations  are  always  made  with  respect  to 
certain  well  known  infectious  diseases  which  our  examination 
leads  us  to  suspect.  In  performing  the  inoculation,  therefore, 
we  must  consider  the  peculiarities  of  these  diseases,  we  choose 
certain  tissues,  fluids  or  other  substances  for  our  inoculating 
material,  we  follow  a  certain  method  of  inoculation  and  make 
use  of  particular  animals. 

For  inoculation  we  use 

1.  Material  of  known  composition  (tu- 
berculin, mallein)  in  order  to  determine  the  condi- 
tion of  the    animals     from  the  resulting  reaction. 

2.  Tissue  and  other  miterial   from  diseased    an- 


DIAGNOSTIC    INOCULATION.  219 

imals    on    test    or    experimental    an- 
imals   in  order  to  determine  the  pathogenic  char- 
acter of  the  inoculated  material. 
Diagnostic    inoculations    are   of   particular   value    in   the 
infectious  diseases  which  follow. 

I.     Tuberculosis. 

Tuberculosis  can  be  recognized  in  only  a  small  per  cent, 
of  afifected  animals  by  the  use  of  ordinary  clinical  methods. 

On  the  one  hand  only  a  few  symptoms  can  be  determined, 
on  the  other  hand  these  symptoms  are  not  characteristic  be- 
cause they  also  occur  in  other  diseases.  The  discovery  of  the 
tubercle  bacillus  as  the  cause  of  tuberculosis  is  hardly  of  any 
value  in  the  clinical  diagnosis  of  the  disease  in  animals.  Mor- 
bid products  from  an  affected  organ  (lung  of  cow)  for  micro- 
scopical examination,  are  difificult  to  obtain ;  the  quantity  is 
small  and  besides  is  swallowed  by  the  animal  as  soon  as  it 
.reaches  the  pharynx.  But,  an  opportunity  to  examine  patho- 
logical nasal  secretions,  ejections,  vaginal  discharges  or  patho- 
logically altered  milk  must  never  be  neglected.     (See  p.  94.) 

Under  these  circumstances  the  experimental  de- 
termination of  this  disease  is  of  great  impor- 
tance. For  this  purpose  we  resort  to  the  tuberculin 
test  and  to  the  inoculation  of  small  experimental 
animals. 

The  tuberculin  test.  Tuberculin  is  the  toxin  of  the 
tubercle  bacilli,  obtained  from  artificial  cultures  of  the  same. 
The  tubercle  bacilli  are  cultivated  for  six  weeks  in  5%  glycer- 
ine beef  bouillon  at  38°  C.  [100.4°  F.]  The  culture  is  thea 
sterilized  at  110°C.  [230°  F.]  and  filtered  through  unglazed 
porcelain  tubes.  The  filtrate  is  evaporated  to  one-tenth  its 
volume  and  thus  constitutes  tuberculin.  After  these  manipu- 
lations the  tuberculin  is  absolutely  free  from  germs  and  there- 
fore it  could  never  produce  tuberculosis.  Furthermore,  it  has 
no  permanent  injurious  influence  on  either  sick  or  healthy  an- 


220  CLINICAL   DIAGNOSTICS. 

imals ;  during  the  tuberculin  test  the  quality  of  the  milk 
is  in  no  way  affected,  but  the  quantity  may  suffer  to 
the  extent  of  a" reduction  of  10%  or  less,  for  a  few  days.  In 
cattle  with  very  advanced  tuberculosis  the  disease  has  been  ob- 
served to  have  become  aggravated  —  according  to  reports. 

Dos  e.*  The  tuberculin  prepared  as  above  described  is 
diluted  with  9  volumes  of  water  to  which  ^%  of  carbolic 
acid  has  been  added.  Cattle  and  horses  receive  5  cc  of  this 
solution,  yearlings  2.5  cc,  calves  1  cc  and  dogs  0..j  — Ice. 

Technique.  The  tuberculin  is  injected  subcutane- 
ously  at  the  neck  or  in  front  of  the  shoulder.  Before  and 
after  using,  the  hypodermic  syringe  should  be  disinfected  with 
a  2%  solution  of  carbolic  acid.  Before  inserting  the  hypo- 
dermic needle  smooth  down  the  hair  at  the  point  of  injection. 
Disinfection  of  the  injected  area  is  not  necessary  if  care  is 
exercised  otherwise.  The  best  time  for  injection  is  in  the 
evening  between  9  and  10  o'clock.  The  bodily  temperature  of 
the  animal  to  be  injected  should  have  been  ascertained  at  noon 
of  the  day  of  injection  and  also  just  before  injection.  Eight 
or  nine  hours  after  injection  of  the  tuberculin,  hence  at  6  A. 
M.,  next  day,  the  temperature  of  each  animal  should  again  be 
taken,  and  thereafter  every  two  hours  until  the  18th  hour 
after  injection.  Perhaps  it  is  unnecessary  to  state  that  the 
temperatures  should  be  recorded. 

Interpretation  of  Results.  In  tuberculous  animals  the 
injection  of  tuberculin  produces  fever  (reaction),  healthy  an- 
imals  are  not  affected. 

a.  Cattle  with  pre-injection  temperatures  not  exceeding 
39.5°  C.  [103.1°  F.J  and  post-injection  temperatures  exceed- 
ing 39.5°  C.  [103.1°  F.],  providing  tht  difference  between 
the  highest  pre-injection  temperature  and  the  highest  post-in- 

[*This  applies,  of  course,  to  the  German  tuberculin.  In  America  the  article  is  man- 
ufactured by  a  number  of  reliable  firms.  It  should  always  be  used  as  fresh  as  possible 
and  the  dose  regulated  according  to  the  strength  of  the  material.  This  is  always  indi- 
cated in  the  "directions  for  use."] 


DIAGNOSTIC    INOCULATION.  221 

jection  temperature  is  at  least  1°  C.  [1.8°  F.]  are  regarded  as 
tuberculous.  - 

b.  In  calves  under  6  months  of  age  a  rise  of  temperature 
exceeding  40°  C.  (104°  F.)  after  injection  of  the  tuberculin, 
provided  the  difference  between  the  highest  pre-  and  post- 
.injuction  temperatures  is  at  least  1°  C.  (1.8°  F.)  indicates 
the  existence  of  tuberculosis. 

The  International  Veterinary  Cragress  of  Budapest  has 
accepted  the  following  interpretation  of  the  results  of  a  tuber- 
culin test : 

1.  A  post-injection  temperature  exceeding  40°  C.  [104° 
F.],  provided  the  temperature  at  the  time  of  injection  did  not 
exceed  39.5°  C.  (103.1°  F.),  is  to  be  regarded  as  a  positive 
reaction. 

If  the  pre-injection  temperatures  of  cattle  exceed  39.5°  C. 
C.  [103.1°  F.]  and  40°  C.  [  104.0 °F.]  the  results  are  to  be 
regarded  as  doubtful  and  to  be  considered  upon  their  own 
merits. 

If  the  pre-injection  temperatures  of  cattle  exceed  39  :5°  C. 
[103.1°  F.],  or  if  those  of  calves  less  than  six  months  of  age 
exceed  40°  C.  [104.0°  F.],  the  tuberculin  test  should  be  made 
at  a  later  date. 

Reliability.  The  tuberculin  test  cannot  be  regarded 
as  absolutely  infallible.  About  90%  of  the  tuberculous  ani- 
mals give  a  reaction.  Animals  in  advanced  stages  of  the  dis- 
ease frequently  do  not  react  As  a  rule,  however,  a  physical 
examination  of  such  animals  reveals  symptoms  which,  when 
considered  alone,  would  at  least  awaken  suspicion  as  to  the 
existence  of  the  disease.  Only  a  small  per  cent,  of  the  react- 
ing animals  is  found  to  be  free  from  tuberculosis.  Neves- 
theless,  tuberculin  is  the  best  diagnos- 
ticum    in     our    possession. 

Inoculation  of  experimental  animals.  The  milk  of 
tuberculous  cows  contains  tubercle  bacilli  when  the  udder  is 
affected   with   tubercular   processes,   and   also   in   some   cases 


222  CLINICAL  DIAGNOSTICS. 

where  tubercular  processes  in  this  organ  seem  to  be  absent. 
Microscopical  examination  of  milk  for  tubercle  bacilli  is  very 
difficult  and  the  results  unreliable,  therefore  we  resort  to 
intraperitoneal  inoculation  of  Guinea  pigs  with  the  fresh  milk 
of  a  suspected  animal.  If  tubercle  bacilli  are  contained  in 
the  milk  tubercular  nodules  will  develop  on  the  peritoneum 
(omentum),  spleen  and  liver  in  the  course  of  two  weeks.  If 
the  Guinea  pigs  do  not  die  before,  they  are  killed  at  the  end 
•of  six  weeks  and  carefully  examined  for  tuberculosis. 

II.     Glanders, 

In  view  of  the  great  infectiousness  and  incurability  of 
glanders,  the  object  of  the  veterinarian  is  to  determine  the 
presence  or  absence  of  this  disease  at  the  earliest  possible 
date.  However,  horses  affected  with  glanders  show  no  symp- 
toms or  at  least  no  characteristic  symptoms  in  the  early  stages 
of  the  disease ;  for  this  reason  horses  that  have  been 
exposed  to  an  infection  with  glanders 
are  subjected, to  a  mallein  test,  with  the 
object  of  thus  enabling  us  to  recognize  the  disease.  If  the 
animals  show  symptoms  of  the  disease  we  endeavor  to  obtain 
some  of  the  pathological  products  or  secretions  and  with  them 
inoculate  experimental  animals  which  are  known  from  experi- 
ence to  be  susceptible  to  the  disease  and  develop  it  in  a  char- 
acteristic form. 

Mallein  inoculation.  ^lallein  is  the  toxin  of  the  bacilli 
of  glanders  and  is  obtained  from  their  cult-ures  in  a  manner 
analogous  to  that  employed  for  obtaining  tuberculin.  The 
crude  preparation  is  a  fluid,  obtainable  from  the  manufacturer 
and  injected  in  doses  designated.  It  may  also  be  obtained  in 
the  dry  or  powdered  form  and  is  thus  injected  in  doses  of  0.02 
— 0.1  G.  according  to  the  weight  of  the  animal.  It  is  best 
to  have  the  solution  of  the  dry  tuberculin  prepared  by  the 
manufacturer. 


DIAGNOSTIC    INOCULATION.  223 

Technique.  This  is  the  same  as  for  tuberculin  inocu- 
lation. Taking  temperature  of  animal  to  be  tested,  two  or 
three  times  at  definite  intervals  before  inoculation ;  inoculation 
between  10-12  P.  M.,  and  taking  temperatures  again  on  next 
day  beginning  at  5  A.  M.,  and  repeating  every  two  hours  until 
6  P.  M. 

Interpretation  of  Results.  The  International  Veterin- 
ary Congress  has  accepted  the  following  principles  for  guid- 
ance in  interpreting  the  results  of  a  mallein  test : 

1.  A  positive  reaction  to  mallein  confirms  the  diagno- 
sis of  glanders  only  when  it^possesses  a  typical  character. 

2.  A  typical  reaction  consists  of  an  elevation  of  temper- 
ature of  at  least  two  degrees  centigrade  [3.8°  F.]  and  must 
exceed  40°  C.  [104°  F.]  The  temperature  curve  usually  re- 
mains at  an  elevation  for  some  time  or  it  may  make  a  slight 
drop  and  rise  again  on  the  same  day.  On  the  second,  and 
sometimes  on  the  third  day.  there  will  be  more  or  less  eleva- 
tion of  temperature.  A  local  as  well  as  a  general  or  con- 
stitutional reaction  is  also  observed. 

3.  Elevations  of  temperature  less  than  40°  C.  [104°  F.], 
as  well  as  greater  elevations  of  an  atypical  character  require 
re-testing  of  the  animal. 

.      4.     Gradually  attained  high  temperatures  of  considerable 
duration,  eVen  if  not  typical,  indicate  the  existence  of  glanders. 

5.  A  local  typical  infiltration  ol  the  tissues  at  the  point 
of  inoculation  is  a  positive  indication  of  the  existence  of 
glanders,  even  in  cases  where  no  thermal  or  general  organic 
reaction  occurs. 

6.  All  malleinized  animals,  whether  they  react  or  not, 
must  be  subjected  to  the  mallein  test  twice,  at  intervals  of  ten 
to  twenty  days. 

The  results  of  the  mallein  test  cannot  be  compared  with 
those  of  the  tuberculin  test ;  they  are  less  reliable.  There  is 
no  doubt  that  the  varying  results  obtained  from  the  use  of 


224  CLINICAL  DIAGNOSTICS. 

malleiii  are  due  to  differences  in  the  character  of  the  mallein 
used. 

Inoculation  of  experimental  animals.  A  male  Guinea 
p\E^  is  inoculated  subcutaneously  at  the  abdomen  with  nasal 
secretion,  pus,  etc.,  from  a  suspicious  subject.  If  the  inocu- 
lated material  contains  the  bacilli  of  glanders  a  local  abscess 
will  develop  at  the  point  of  inoculation  and  a  firm  hot  swelling 
appear  in  the  region  of  the  thigh.  After  2-4  weeks  the 
Guinea  pig  is  killed  with  chloroform.  The  presence  of  the 
characteristic  nodules,  etc.,  of  glanders,  in  the  region  of  the 
point  of  inoculation  and  in  the  testicles  confirms  the  diagnosis. 
The  method  of  Strauss,  consisting  of  the  intra-peri- 
toneal  inoculation  of  male  Guinea  pigs,  is  of  more  recent  intro- 
duction. With  a  cotton  swab  dip  up  some  of  the  suspicious 
material  from  an  ulcer  or  from  nasal  secretion,  rinse  in  a  few 
cubic  centimeters  of  sterilized  water,  and  inject  one  or  two 
cubic  centimeters  of  this  fluid  into  the  abdominal  cavity  of  each 
of  several  Guinea  pigs.  If  the  inoculated  material  contained 
the  bacilli  of  glanders,  reddening  and  swelling  of  the  scrotum 
and  adhesion  of  the  testicles  will  occur  in  the  course  of  two 
or  three  days.  More  or  less  isolated  pus  centers  develop  on 
the  tunica  vaginalis  and  cause  an  adhesion  of  the  peritoneal 
folds.  Sometimes  a  single  center  at  the  point  of  inoculation, 
constitutes  the  only  lesion.  The  danger  of  a  general  septic 
infection,  from  the  impure  material,  may  be  obviated  by  keep- 
ing the  infected  swabs  in  a  refrigerator  for  a  few  days.  Pota- 
to cultures  should  always  be  made  from  the  lesions  of  the 
scrotum.  The  true  glanders  bacillus  produces  yellow  colonies 
resembling  honey'  in  color,  while  the  pseudobacillus  of  glan- 
ders (Kutscher)  produces  white  colonies. 

Cats,  also,  are  suitable  animals  for  inoculation.  They  are 
inoculated  at  the  back  of  the  neck. 

Serum  Diagnosis  of  Glanders.  (Agglutination  Test). 
Scientific  investigation  has  shown  that  bacteria  suspended  in 
fine  emulsion,  when  acted  upon  by  their  respective  immuno- 


DIAGNOSTIC    INOCULATION.  225 

toxins  (serums)  become  agglutinated  (clumped)  and  sink 
to  the  bottom  of  the  liquid  in  which  they  were  suspended. 
This  knowledge  has  also  been  made  use  of  in  the  diagnosis  of 
glanders.     The  technique,  according  to  Schuetz,  is  as  follows : 

Disinfect  the  skin  overlying  the  jugular  vein  of  the  sus- 
pected horse,  insert  a  hypodermic  needle  and  withdraw  about 
30  to  50  cc  of  blood  into  a  sterilized  flask,  then  seal  care- 
fully. The  serum  is  allowed  to  separate  and  is  then  diluted 
to  various  strengths  by  the  addition  of  a  physiological  salt 
solution. 

The  test  fluid  is  prepared  from  virulent  cultures  of 
glanders  bacilli  that  have  been  heated  in  a  thermostat  for  two 
hours  at  a  temperature  of  60°  C.  [140°  F.]  in  order  to  kill 
the  bacteria.  To  this  material  is  added  a  sufficient  quantity 
of  carbolized  sodium  chloride  solution  to  make  an  emulsion 
which,  in  reflected  light,  has  a  slightly  milky  appearance. 

Two  cubic  centimeters  of  the  test  fluid  are  added  to  vary- 
ing proportions  of  the  blood  serum  of  the  suspected  horse 
and  kept  in  a  thermostat  at  30°  C.  [86°  R]  for  from  24  to  30 
hours.  If  the  serum  agglutinates  the  bacilli  when  diluted  in 
the  proportion  of  1 :1000,  or  more,  the  horse  from  which  it 
was  obtained  is  regarded  as  glandered.  x\n  agglutination  re- 
sulting from  a  dilution  of  the  serum  of  1 :500  to  1 :1000  indi- 
cates probable  infection,  and  an  agglutination  power  of  less 
than  1.500  indicates  the  absence  of  infection.  The  making  of 
a  successful  agglutination  test  requires  not  only  fresh  and 
virulent  cultures  of  glanders  bacilli,  but  also  a  certain  degree 
of  skill  and  the  necessary  experience.  For  this  reason  it  can 
be  successfully  performed  in  bacteriological  laboratories  only. 
The  function  of  the  practicing  veterinarian,  therefore,  should 
be  limited  to  the  collection  of  the  serum  from  the  suspected 
animal  which  should  then  be  forwarded  to  the  proper  state 
authorities,  board  of  live  stock  commissioners  or  board  of 
health. 


226  CLINICAL   DIAGNOSTICS. 

III.     Anthrax,  Blackleg,  Malignant  Oedema  and  Wild-und 
Rinder-seuche. 

On  account  of  their  rapid  course,  the  clinical  diagnosis 
of  these  diseases  is  often  impossible ;  besides,  the  symptoms  of 
the  different  diseases  are  often  much  alike  and  hence  a  dif- 
ferentiation impossible.  Although  a  microscopical  examination 
of  the  blood  (or  exudate)  of  animals  that  died  of  one  of  these 
diseases  suffices  to  recognize  their  character  by  finding  the 
characteristic  organisms,  still  there  are  cases  where  an  inocu- 
lation alone  can  decide  the  question.  We  use  rabbits  for  this 
purpose  and  inoculate  them  cutaneously  (!)  in  the  ear,  with 
blood  or  exudate  from  the  animal  or  carcass  in  question.  If 
the  rabbit  dies  the  disease  is  either  anthrax  or  Wildseuche 
because  blackleg  and  malignant  oedema  are  not  transmissible 
by  means  of  cutaneous  inoculation.  The  differentiation 
between  anthrax  and  Wildseuche  is  made  by  a  bacterioscopic 
examination  of  the  dead  rabbit.  It  is  also  worthy  of  note  that 
in  Wildseuche  there  is  always  a  severe  tracheitis. 

In  case  the  rabbit  does  not  die.  it  is 
again  inoculated  ;  this  time  s  u  b  c  u  t  a  n  e  o  u  s  1  y ;  if  death 
follows,  it  was  a  case  of  malignant  oedema  because  rabbits  are 
immune  against  blackleg.  The  presence  of  blackleg  can  be 
demonstrated  by  inoculating  a  Guinea  pig  with  the  suspected 
material ;  death  following  in  a  few  days  after  inoculation. 

\\'e  can  expedite  matters  by  simultaneously  inoculating 
one  rabbit  cutaneously  and  another  rabbit  and  a  Guinea  pig 
subcutaneously.  If  all  three  animals  die  we  had  anthrax  (or 
Wildseuche)  if  only  the  two  subcutaneously  inoculated  ani- 
mals die  it  was  a  case  of  malignant  oedema,  and  in  case  it  was 
blackleg  only  one  animal,  the  Guinea  pig.  is  sacrificed. 

*If  we  desire  additional  proof  by  having  the  blood  of  a 
suspected  anthrax  carcass  examined  by  a  second  person  we 
may  boil  a  potato,  upon  cooling  cut  it  in  halves  with  a  steri- 

*  [This  method  is  commonly  resorted  to  in  Germany.] 


DIAGNOSTIC    INOCULATION.  22T 

lized  (flamed)  knife,  apply  some  of  the  suspected  material  to 
the  surface  of  one  half,  replace  the  other  half,  pack  carefully 
and  send  it  to  the  official  bacteriologist.  Blood  sent  in  a  flask,, 
is  usually  not  adapted  for  microscopical  examination. 

IV.     Rabies. 

Suspected  dogs  are  usually  killed  before  they  can  be  sub- 
jected to  examination  by  an  expert.  A  post  mortem  examina- 
tion will  then  hardly  enable  us  to  make  a  definite  positive 
diagnosis ;  we  must  resort  to  inoculation  of  a  test  animal. 
The  di'a  gnostic  inoculation  of  a  rabbit 
with  the  brain  matter  ofa  suspecteddog 
is  the  onl}^  absolutel}-  safe  method  of 
definitel}'  determining  the  presence  of 
rabies. 

Technique.  The  brain  and  cervical  cord  of  the  sus- 
pected dog  are  carefully  removed.  The  medulla  oblongata  is 
severed  from  the  brain  by  an  incision,  at  the  pons  Varolii, 
made  with  a  "flamed"  knife.  A  piece  of  the  medulla  (size  of 
a  pea)  is  removed  with  sterilized  scissors  from  the  cut  surface, 
placed  into  a  sterilized  porcelain  vessel  and  thoroughly  tritu- 
rated with  a  small  quantity  of  distilled  water.  This  emulsion 
is  used. for  inoculation. 

1.  The  Intra-ocular  method  according  to  Johne.  Two 
rabbits  are  inoculated,  each  receiving  a  few  drops  of  the  emul- 
sion into  the  anterior  chamber  of  the  eye ;  injected  with  a  ster- 
ilized hypodermic  syringe.  If  the  hypodermic  needle  is  fine 
and  sharp  and  the  rabbit's  eye  has  been  previously  dis- 
infected and  anesthetized  the  operation  can  be  per- 
formed with  little  difficulty.  We  insert  the  needle  at  the  bor- 
der of  the  cornea,  directing  it  toward  the  median  line.  If  the 
operation  was  carefully  conducted  a  slight  turbidity  of  the 
cornea,  which  soon  disappears,  is  the  only  symptom  that  fol- 
lows. 


228  CLINICAL  DIAGNOSTICS. 

If  rabies  is  present  the  first  symptoms  appear  in  from  2 
weeks  to  23  days ;  the  animals  are  shy,  crawl  away,  and  show 
loss  of  appetite.  After  12  hours  paralysis  and  difficult  deglu- 
tition is  observed,  the  animals  emaciate  rapidly,  grit  their  tetth 
and  emit  a  cry  when  touched  on  the  head.  The  disease,  thus 
produced,  terminates  fatally  within  48  hours. 

2.  Subdural  Inoculation.  Carefully  trephine  the 
frontal  bone  of  a  rabbit,  observing  the  necessary  antiseptic 
and  anatomical  precautions.  By  means  of  ^  sterilized  glass 
syringe  having  its  nozzle  bent  at  right  angles,  inject  a  few^ 
drops  of  the  emulsion  under  the  duramater,  stitch  the  wound 
and  protect  with  collodion,  or  absorbent  cotton. 

If  the  inoculation  material  is  fresh  and  virulent,  death 
will  follow  in  two  or  three  weeks.  Sometimes  the  animals 
die  as  early  as  the  11th  day,  or  may  live  until  the  30th  day. 
[In  some  cases  six  weeks  will  elapse  before  the  first  symptoms 
of  the  disease  can  be  observed.] 

3.  Intra-muscular  Inoculation.  If  the  suspected  nerve 
tissue  has  begun  to  decompose,  or  if  suspicion  exists  that  it 
may  not  be  fresh,  it  should  be  immersed  in  a  one-half  per  cent, 
solution  of  carbolic  acid  and  placed  in  the  refrigerator  for  24 
hours.  It  is  then  removed  and  carefully  triturated  with 
beef  broth  until  a  fine  emulsion  results.  Rabbits  receive  from 
three  to  five  cubic  centimeters  of  this  emulsion  injected  into 
the  dorsal  muscles  in  the  region  of  the  loins.  As  a  rule  septic 
infection  can  be  avoided  in  this  way  while  the  virulence  of 
the  material  is  otherwise  unaffected.  Death  follows  after  two 
or  three  weeks  or  somewhat  later. 

The  symptoms  following  subdural  and  intra-muscular  in- 
oculation are  much  the  same.  After  ten  or  twelve  days  ema- 
ciation sets  in,  followed  by  paralysis  of  the  hmd  parts,  and 
death  two  or  three  days  later. 

4.  Subconjunctival  Inoculation.  This  is  recom- 
mended by  Szpilman  as  easy  of  execution  and  certain  in  its 
results. 


THE    LYMPHATIC    GLANDS.  229 

In  the  "Tollwuthabteilung  of  the  Institut  fuer  Infections- 

krankheiten,"  in  Berhn,  the  subdural  and  the  intra-muscular 

inoculations  are  used  exclusively,  sometimes  both  methods  are 

used  at  the  same  time.     (Beck). 

Differential  diagnosis.  Beck  calls  attention  to  the  fact  tha^ 
material  obtained  from  dogs  affected  with  the  nervous  form  of  dis- 
temper will  produce  paralysis  of  the  hind  parts  of  rabbits  that  have 
been  inoculated.  In  tlrese  cases  the  paralysis  is  not  confined  to 
the  posterior  extremities,  but  extends  to  the  bladder  and  rectum 
Rabbits  thus  affected  become  soiled  with  feces  and  urine.  This 
affection  cannot  be  transmitted  to  a  second  generation  of  rabbits. 

14.     The  Lymphatic  Glands. 

The  intermaxillary  lymphatic  glands  of  horses  are  always 
subjected  to  an  examination  in  diseases  of  the  respiratory  ap- 
paratus. Otherwise  they  are  subjected  to  s  p  e  c  i  a  1  exam- 
inations only  when  infectious  diseases,  glanders  and 
tuberculosis,  constitutional  blood  diseases  (leuce- 
m  i  a  )  or  the  presence  of  malignant  tumors  (carcinoma 
and  sarcoma)  are  suspected.  Examination  consists  in 
palpation  (conducted  according  to  the  rules  given  on  p.  21). 
The  correct  interpretation  of  these  changes  was  discussed 
under  "intermaxillary  lymphatic  glands." 

When  an  examination  is  called  for,  the  following  lym- 
phatic    glands     must  be  considered : 

1.  I  n  t  e  r  m  a  x  i  11  a  r  3'     1  3-  m  p  h  a  t  i  c     glands,    1  y  m  - 
p  h  o  -  g  1  a  n  d  u  1  a     s  u  b  m  a  x  i  11  a  r  i  s  .     In  the  ox  these  are  of 
the  size  of  half  a  walnut  and  are  situated  on  the  median  side  of  the 
submaxilla,   near  its  border  and  in   the   region   of  the  point   of  in-  ' 
sertion  of  the  muse,  sterno-maxillaris. 

2.  Lymphatic  g  1  a  n  d  s  o  f  the  parotid  region, 
1  y  m  p  h  o  g  I  a  n  d  u  1  a  p  a  r  o  t  i  d  e  a  e  .  These  are  between  and 
below  the  lobules  of  the  parotid  gland.  In  the  ox  they  have  the 
shape  of  a  flattened  tongue  and  a  length  approaching  6cm.;  this 
gland  projects  from  beneath  the  border  of  the  parotid  gland,  below 
the  maxillary  articulation. 

3.  T  li  e  superior  cervical  glands  1  y  m  p  h  o  - 
glandula  cervicales  superiores,  and  retro- 
pharyngeales  are  situated,  as  the  name  implies,  on  the  pos- 
terior wall  of  the  pharynx.  In  the  ox  they  consist  of  a  closely 
united  packet,  about  5cm.  long,  under  the  lateral  processes  of  the 
atlas,  where  they  can  be  felt  by  placing  the   thumb  on  the  lateral 


230 


CLINICAL  DIAGNOSTICS. 


process  of  the  atlas  (both  sides  simultaneously)  and  thus  pressing 
the  finger  tips  behind  the  pharynx  and  then  against  the  inferior 
face  of  the  lateral  processes  of  the  atlas. 

4.  In  the  ox  a  few  large  lymph  follicles  in  the  depression  in 
front  of  the  shoulder  (prescapular  glands)  and  on  the 
chest  in  front  of  the  elbow  articulation  (prepectoral 
glands). 

Fig.  53. 


Lymph  glands  of  the  ox  accessible  by  external  palpation. 

5.  The  lymphatics  of  the  shoulder  (pre- 
scapular glands)  are  covered  by  the  mastoido-humeralis 
muscle  in  front  of  the  scapulo-humeral  articulation. 

6.  The  precrural  glands  lie  at  the  anterior  border 
of  the  tensor  fascia  lata  muscle;  distinctly  visible  in  cattle. 

7.  In  the  upper  part  of  the  flank  of  the  ox 
four  or  five  follicles  as  large  as  a  lentil  can  frequently  be  felt  sub- 
cutaneously. 

8.  The  deep  inguinal  glands  lie  in  the  crural 
canal  covering  the  crural  vessels. 

[The  superficial  inguinal  glands  in  the  male 
animal  at  the  neck  of  the  scrotum  on  each  side  of  the  penis  in  the 
sheath.     In  the  female  as  follows:] 

9.  The  retromammary  glands  (glands  of  the  udder) 
are  especially  well  developed  in  the  cow  and  are  situated  behind 
and  above  the  udder. 

10.  The  mesenteric,  lumbar  and  sacral  glands 
of  the  horse  and  cow  can  be  examined  per  rectum.  In  the  former 
the  bowel  should  be  evacuated  by  means  of  a  cathartic;  for  the  lat- 
ter it  is  at  least  advisable     to     do     so. 


THE    BLOOD. 


231 


In  the  healthy  horse  we  can  distinctly  feel  the  intermax- 
illary glands,  in  the  healthy  ox  the  precrural  glands,  and  no 
others;  if  any  of  the  other  glands  are  distinctly  palpa- 
ble    we  assume  that  they  are  e  n  1  a  r  g  e  d  . 

The  intermaxillary  lymphatic  glands 
of  the  horse  are  sometimes  extirpated  in 
order  to  subject  them  to  a  special  macroscopical,  or  microscop- 
ical and  bacteriological  examination.  For  diagnostic  purposes 
we  resort  to  it  in  glanders  only.  We  operate  on  the  standing 
animal  and  anesthetize  according  to  Schleich's  method. 

15.     The  Blood. 

The  examination  of  the  blood  is  of  importance  in  a  few 
rare  cases  only.     A  microscopical  examination  to  determine 

Fig.  54. 


Leucemic  Blood. 

the  presence  of  certain  infectious  diseases  is  of  value  only  in 
anthrax  and  Rothlauf  in  pigs,  and  even  in  these  diseases  the 
circulating  blood  contains  only  few  organisms.  However,  i  n 
T  e  X  a  s  fever  it  is  of  diagnostic  importance,  and  in  con- 
stitutional blood  diseases  it  is  equally  invaluable. 

The  best  way  to  obtain  the  necessary  blood  is  to  make  a 
sHght  incision  into  the  lip,  with  the  point  of  a  knife,  observing 


232  CLINICAL  DI.\GXOSTICS. 

care  not  to  stretch  the  skin  ckiring  the  operation.  If  a  larger 
quantity  of  blood  is  desired  a  hypodermic  needle,  inserted  into 
the  jugular  vein,  answers  the  purpose  better.  [As  far  as  an- 
noyance of  the  animal  is  concerned,  tapping  the  jugular  vein 
is  preferable  in  all  cases.]  In  practice  we  may  limit  our- 
selves to  the  microscopical  examination :  for  this  purpose  a 
single  drop  of  blood,  placed  directl\-  on  the  glass  slip  or  cover, 
will  serve  the  purpose.  From  this  drop  we  can  make  a  few 
cover  glass  preparations,  allow  them  to  dry,  take  them  home, 
fix.  stain  and  examine  them  at  leisure ;  or  we  may  add  a  0.3% 
solution  of  sodium  chloride  and  examine  the  blood  in  its  fluid 
condition.  Exact  blood  examinations  are  difficult  and  must  be 
carried  out  with  such  care  and  minuteness  that  the  practitioner 
is  obliged  to  get  along  with  the  results  of  the  simplest  meth- 
FiR-.  55.  ods.     For  those  who  care  to  take 

/?  P\    ^    f^^  "P  ^^^^  study  of  blood  examinations 

A     ^  G  in  detail  we  recommend  "Jacksch- 

^        *^    <9/J        c^  Klinische  Diagnostik." 

y\  ^  J)       rf^  Number  of  blood  corpuscles. 

^r^  0      On  ^^^^  absolute  number  of  blood  cor- 

*\r\-~.     rr>         ^        puscles  in  a  given  amount  of  blood 

^^  <^N  ®  ^  ^^^^   °"^-^    ^^    determined    with   the 

Abnorn^ai  Forms  of  Red  aid  of  Special  blood-couuting  appa- 

Corpuscies.  j.^^^^^    ( Thoma-Zciss) .      According 

to  the  investigations  of  Storch,  the  number  and  proportion  of 

red  and  white  corpuscles  per  cubic  millimeter  are  as  follows : 

Red  Corpuscles.    White  Corpuscles.    Proportion. 


Stallions 

8.-?  millions    • 

10.500 

1:780 

Geldings 

r.() 

11,000 

1:690 

]\Iares 

7.1 

9.900 

1:720 

Colts 

9.3 

14,000 

1:670 

Bulls 

6.5 

7,800 

1:820 

Steers 

6.7 

9,400 

1:720 

Cows 

5.5 

8.200 

1:660 

Calves 

8.5 

15.700 

1:550 

Dogs 

5.4 

3,100-2,800 

THE    BLOOD.  233 

Since  the  results  of  these  investigations  show  that  con- 
siderable variations  occur  under  normal  conditions,,  extreme 
variations  alone  can  be  regarded  as  being  of  importance. 

An  increase  in  the  number  of  red  corpuscles  has  been 
observed  in  serious  general  diseases  with  fatal  termination: 
pulmonary  gangrene,  angina,  pleuro-pneumonia. 

A  decrease  in  the  number  of  erythrocytes  occurs  in  essen- 
tial anemia,  hydremia,  leukemia,  and  particularly  in  per- 
nicious anemia. 

Shape  of  the  red  blood  corpuscles.  \\^e  usually  group 
them  as  follows : 

1.  Xormal  red  corpuscles,  without  nucleus. 

2.  Nucleated  erythrocytes. 

a.  Normoblasts  of  normal  size. 

b.  ]\Iegaloblasts,  two  or  three  times  the  size  of  nor- 

mal red  corpuscles. 

c.  Gigantoblasts,  still  larger  than  the  megaloblasts. 

d.  !\Iicroblasts,  smaller  than  the  normoblasts. 
When   the   normal   blood   corpuscles    deviate    from    their 

usual  biconcave  form  they  are  called  poikilocytes.  Similarly 
altered  nucleated  red  corpuscles  are  called  poikiloblasts. 

The  red  corpuscles  frequently  undergo  considerable 
change  in  form  in  the  course  of  preparation  for  microscopic 
examination.  This  must  ahvays  be  borne  in  mind  wdien  dif- 
ferentiating between  the  different  groups. 

Varieties  of  the  white  corpuscles.  According  to  Ehr- 
lich  and  his  pupils  the  white  corpuscles  are  classified  as  fol- 
lows : 

1.  Lymphocytes.  These  are  from  6  to  9  micra  in  diam- 
eter, with  a  single,  large,  well-defined  nucleus  containing  an: 
abundance  of  chromatin.  They  stain  with  basic  aniline- 
dyes,  the  protoplasm  absorbing  more  of  the  stain  than  the- 
nucleus. 

2.  Large  Mononuclear  Leucocytes.  These  are  1?  to> 
15  micra  in  diameter,  contain  a  large,  not  well-defined  sin- 
gle nucleus  with  little  chromatin,  and  homogeneous,  baso- 
phile  protoplasm. 


234  CLIXICAL   DIAGNOSTICS. 

Transition  forms  occupy  a  position  between  the  large 
mononuclear  leucocytes  and  the  polynuclear  leucocytes,  their 
nucleus  being-  divided  into  two  or  three  sections.  They  resem- 
ble the  mononuclears  in  their  affinity  for  stains. 

3.  Polynuclear  Leucocytes.  These  are  10  to  12  micra 
in  diameter,  are'  provided  with  a  slender  but  broken  and 
irregular  nucleus  containing  an  abundance  of  chromatin  and 
a  finely  granular,  opaque,  neutrophile  protoplasm. 

4.  Eosinophile  Leucocytes.  These  are  12  to  15  micra 
in  diameter,  the  body  of  the  cell  is  filled  with  large  roundish 
granules  which  have  an  exceptional  affinity  for  eosin  and  other 
acid  stains.  They  have  one  or  two  nuclei  which  are  packed  in 
between  the  granules.  The  nuclei  contain  an  abundance  of 
chromatin. 

5.  Mast  Cells.  These  vary  in  size  up  to  that  of  the  eosin- 
ophyles,  they  have  clumsy  nuclei  of  various  forms  containing 
little  chromatin,  and  basophyle,  coarsely  granular  protoplasm. 

According  to  Wiendick  the  varieties  of  leucocytes  occur 
in  the  following  proportions  in  the  blood  of  the  horse: 

Actual  Xo. 

per  cubic 

Percentage,    centimeter. 

1.  Lymphocytes    ". 35-45 2500-3500 

2.  Mononuclear  Leucocytes    1.5-3.5.  . .  .150-300 

3.  Neutrophyle  Polynuclear  Leucocytes  SO-TO 4000-5000 

4.  Acidophvle  Leucocytes .1.5-5.0.  .  .  ,200-350 

5.  Mast  Cells  (Basophyle  leucocytes) .  .0.2-0.7 20-60 

It  is  not  unusual  to  observe  even  greater  variations  than 
those  shown  in  the  table. 

A  temporary  increase  in  the  actual  number  of  leucocytes 
(hyperleucocytosis)  may  occur  after  feeding  and  in  animals 
in  advanced  pregnancy.  Such  an  increase  is  also  observed  in 
the  course  of  all  infectious  inflammatory  processes,  especially 
during  the  formation  of  abscesses  in  the  course  of  strangles. 

The  actual  number  of  leucocytes  is  reduced  (hypoleucocy- 
tosis)    permanently  in   the  course  of  pernicious  anemia.      In 


THE    BLOOD,  235 

this  disease  the  relative  proportion  of  red  corpuscles  is  less 
than  normal. 

The  normal  color  of  blood  serum  is  a  light  golden 
yellow  (straw  color).  After  the  destruction  or  breaking  down 
of  a  large  number  of  red  corpuscles  their  coloring  matter  is 
dissolved  in  the  plasma  of  the  blood  and  is  partially  converted 
into  methemoglobin.  This  causes  a  reddening  of  the  serum 
(Hemoglobinemia).  The  presence  of  the  coloring  matter  of 
the  muscles  may  produce  a  similar  result. 

Diseases  of  the  Blood. 

Essential  (idiopathic)  anemia.  Bloodlessness.  Consists  in  a 
diminishment  of  the  quantity  of  blood  without  a  determinable' 
cause.  Blood  pale  and  coagulates  poorly.  Mucous  membranes 
pale  and  low  temperature.  Pulse  small,  heart  tones  metallic 
sound.  Appetite  poor.  Tendency  to  dropsical  swellings.  General 
weakness.     Mostly  in  young  animals. 

Pernicious  anemia.  Primary  anemia  of  adult  animals  with 
fatal  termmation.  Fever  not  constant.  Mucous  membranes  pale 
and  somewhat  yellowish.  Pulse  gradually  becoming  more  rapid, 
appetite  less  and  less.  Increased  weakness  terminating  in  death 
Blood  watery,  changes  in  red  corpuscles  characteristic:  usually 
large  ones  with  nuclei,  and  small  irregular  forms,  seem  elongated 
angular  or  toothed,  club  or  pear  shaped. 

Leucemia.  Chronic  alterations  of  the  blood  and  increase  in 
number  of  white  corpuscles.  Animals  are  languid,  lazy,  sweat 
easny,  pale  mucous  membranes.  Appetite  grows  less,  pulse  in- 
creases, small.  Heart  tones,  metallic  sound.  Enlargement  of  lym- 
phatic glands  usually  present.  Sometimes  ecchymotic  hemor- 
rhages in  the  mucous  membranes. 

Hemoglobinuria  of  cattle.  An  acute  non-contagious  infec- 
tious disease  of  cattle  caused  by  the  presence  of  the  protozoon 
Pyroplasma  bigeminum  m  the  blood,  and  characterized  by  hemo- 
globinuria. About  12  days  after  the  animals  have  been  on  an  in- 
fected pasture,  the  first  symptoms  appear— fever,  loss  of  appetite 
diarrhea.  Urine  light  to  dark  red,  very  foamy,  urination  painfuL 
Urine  contains  hemoglobin  and  coagulates  into  a  gelatinous  mass 
vvhen  boiled.  Gait  stifif  and  clumsy,  often  attended  with  pain 
Also  anemia,  icterus,  general  debility,  continuous  lying  down 
edematous   swelling  of  head   and  neck. 

The  cause  of  the  disease  is  found  in  the  blood  in  the  form  of 
a  protozoon  called  Pyroplasma  bigeminum.  The  latter  has  a 
roundish  form  which  may  become  very  irregular  as  a  result  of 
ameboid    movement. 

When  fully  developed  they  are  found  in  the  red  corpuscles  in 
the    form    of   two    pear    shaped    bodies    with    the   narrow    ends    ap- 


236  CLINICAL  DIAGNOSTICS. 

preaching  each  other,  or  in  actual  contact.  They  are  2.5-4  micra 
long  and  1.5  to  2  micra  wide.  Two  per  cent,  of  the  red  corpuscles 
in  the  circulating  blood  are  infected,  while  50%  of  the  red  corpus- 
cles of  the  capillaries  of  the  organs  contain  the  parasites. 

The  presence  of  the  parasites  is  easily  demonstrated  by  fixing 
smear  preparations  in  absolute  alcohol  and  staining  with  alkaline 
methylene  blue. 

Texas  Fever.  Is  an  infectious  disease  of  cattle  caused  by 
Pyrosoma  bigeminum  [indirectly  by  the  presence  of  Texas  fever 
ticks,  Boophilus  bovis].  Period  of  incubation  10-15  days.  High 
and  continuous  fever,  rapidly  progressing  anemia,  red  corpuscles 
reduced  in  number  from  six  million  to  one  million  per  cc.  Hema- 
globinuria.     Fatal  termination  the  rule. 

Pyrosoma  bigeminum  is  a  minute  pale  protozoon  of 
a  roundish  form  found  in  the  red  corpuscles.  It  possesses  ame- 
boid movement  and  can  therefore  assume  irregular  shapes.  When 
fully  developed  the  parasites  occur  as  two  pear-shaped  bodies  with 

Fig.  56. 


Different  stages  of  development  of  Pyrosoma  bigeminum  in  red  blood  corpuscles. 

their  pointed  ends,  converging.  They  are  2.5  to  4  micra  long  and 
1.5  to  2  micra  wide.  In  the  circulating  blood  1  to  2%  of  the  blood 
corpuscles  are  infected,  in  the  capillaries  of  the  various  organs 
more  than  half  of  them  contain  the  parasites. 

Malaria  A  non-contagious  infectious  disease  caused  bj'  Plas- 
modium malariae.  Remittent  fever,  pronounced  icterus,  petechiae, 
cerebral  depression,  small  rapid  pulse.  Loss  of  appetite,  increased 
thirst,  dark-colored  urine  staining  white  hair  A'ellow.  The  malaria 
parasites  which  occur  in  tlie  blood  constitute  a  special  group  of 
protozoons.  They  differ  from  the  Pyrosoma  in  being  pigmented. 
They  may  be  stained  with  methylene  blue.  They  are  bright 
roundish  bodies  with  distinct  outline,  occurring  singly  in  the  red 
blood   corpuscles. 

Flagellosis  of  horses.  ^lal  de  Caderas.  Gradually  rising  re- 
current fever  rarely  exceeding  40°  C.  (104°  F.)  Rapid' emaciation 
in  spite  of  good  appetite.  Paralysis  of  the  hind  quarters,  bladder 
and  rectum.  Edema,  hemoglobinuria,  continuous  lying  down, 
coma,  death.  The  specific  cause  of  the  disease,  Trypanosoma 
equina  (Flagellata)  is  found  in  the  blood  as  an  actively  motile 
parasite.  Smear  preparations  may  be  stained  in  15-20  minutes 
with  carbol-fuchsin  to  which  has  been  added  one-third  volume  of 
glycerine.  Magenta  red,  however,  is  a  better  stain.  The  parasite 
has  the  form  of  a  whip  lash  and  is  three  or  four  times  the  length 

[Malkmus  regards  this  disease  and  hemoglobinuria  of  cattle  (Europe)  as  very  proba- 
bly identical.]— Translators. 


THE    BLOOD.  237 

of  the  diameter  of  a  red  blood  corpuscle.  The  convex  border  of 
the  body  contains  a  delicate  membrane  which  extends  to  the  end 
of  the  body,  forming  a  tail.  The  body  of  the  parasite  contains 
■bright  round  granules  which  do  not  take  the  stain.  Very  destruc- 
tive  in   South   America. 


Fig.  5' 


Nagana,  Tsetse  Disease,  Surra.  Occurs  in  cattle,  solidungula, 
■camels,  dogs  and  cats.  This  is  a  pernicious  anemia  caused  by 
Trypanosoma  Evansi  (introduced  into  the  tissues  through  the  me- 
dium of  the  tsetse  fly).  Fever,  muscular  weakness,  edema,  affec- 
tion of  the  eyes,  pronounced  anemia.  A  flaggellate  parasite,  like 
the  above,  20  to  40  mic,ra  long,  1  to  2.5  micra  in  diameter,  actively 
motile. 


INDEX. 


Abdomen,  133,  145. 

Abnormal  sensitiveness  149. 

Accumulation  of  food  146, 
154. 

Achorion  Schoenleinii,  see 
Favus  54. 

Acne   contagiosa   equor,   see 
Canadian  horsepox  56. 

Actinomycoma  142. 

Actinomycosis  136. 

Albuminuria  GG,  1T4,  176. 

Albumosuria  177. 

Alkalies,  craving-  for  135. 

Alopecia  44,  50. 

Alveolar  periostitis  137. 

Anemia  48,  59,  235. 

— ,  pernicious  235. 

Anesthesia  202. 

Anamnesis  IH. 

Anasarca  47. 

Angina  pharyngea  164. 

Ante-and  post-partum  pare- 
sis 37. 

Anthrax  71,  226. 

Anus  99. 

Apoplexy  205,  208. 

Appetite  134. 

Arteries  79. 

Ascites  40. 

Ascarides  61. 

Atelectasis  27,  122. 

Attitude  33. 

Auscultation  29. 

— of  abdomen  154. 

— of  heart  83. 

—of  lungs  124. 

Azoturia  37,  41. 


Bacillus   pyelonephritis  189. 

Balkiness  183. 

Bird  lice  51. 

Blackleg  57. 

Bladder,  diseases  of  167. 

— ,  examination  of  190. 

Blind  staggers  207,  209. 

Blood  231,  232. 

Blood  sweating,  50. 

Blowing  sound  94,  100. 

Bodily  temperature  62. 

Bovine  pest  57. 

Broken  back  37. 

Bronchial  catarrh  130. 

Bronchiectases  107,  123. 

Bronchitis  102,  130. 

— verminosa  130. 

Bruits,  anemic  87. 

—,  diastolic  85. 

'—,  inorganic  85. 

— ,  systolic  85. 

Cachexia   39. 
Canadian  horsepox  56. 
Carbonate  of  lime  183. 
Cardiac  dullness  83. 
Catarrh  of  maxillary  sinuses- 

129. 
Caverns  in  lungs  123. 
Cerebral  congestion  207. 
— depression  200. 
— ^hemorrhage  208. 
Cerebrospinal  meningitis  38„ 

42,  208. 
Chills   66. 
Choleurea  180. 
Circulatory  apparatus  73. 


239 


Coital  exanthema  197. 
Colic  41,  157,  165. 
Collapse,  temperature  of  70. 
Colostral  milk  195. 
Colpitis  197. 
Coma  200. 
Condition  38. 
Conformation  39. 
Congestion,  cerebral  207. 
Conjunctiva  57. 
Constipation  155,  157,  166. 
Convulsions  202. 
Cough  111. 

— ,  return  impulse  of  114. 
Cracked  pot  resonance  123. 
Cramp    of   the   neck   38,   43, 

203. 
Crisis  70. 
Crusts  50. 
Cystitis  191. 

Defecation  156,  157,  207. 
Deglutition,  difficulties  of 

138. 
Diabetes  171. 
— insipidus  192. 
— mellitus  192. 
Diaphragm,  rupture  of  124. 
Diarrhea  147.  157. 
Dicrotic  pulse  79. 
Dififerential  diagnosis  16. 
Digestive  apparatus   133. 
Dilatation  of  the  heart  88. 
Direct  diagnosis  16. 
Dislocation   of  bowel   124, 

165. 
Distemper  of  dogs  133,  202, 

205. 
— of  horses  132. 
Distoma,  eggs  of  162. 
Diverticula    of   esophagus 

143,  164. 


Dizziness  201,  207. 
Drowsiness  200. 
Dropsy  47. 

Dummies  31,  34,  207,  209. 
Dyspepsia  164 
Dyspnea  34,  96. 
Dysuria  170. 

Ecchymoses  107,  108,  140. 

Echinococcus  disease  131. 

Eclampsia  208. 

Eczema  50, 

Edema  23,  47,  57. 

—of  glottis   129. 

—collateral  48. 

Emphysema  24,  49. 

— ,  alveolar  130. 

— ,  cutaneous  24,  48. 

— ,  interstitial  131. 

— ,  of  skin  48. 

• — ,  septic  48. 

Encephalitis   34. 

Endocarditis,  acute  and 

chronic  88. 
Endometritis  197. 
Enteritis,  hemorrhagic  160. 
Enteroliths  152. 
Epilepsy  203,  207,  216,  217. 
Epithelial  casts  189. 
—cells  187. 
B>uctation  144. 
Esbach's  albuminimeter  176. 
Esophagus  146. 
Excitability,  abnormal  210. 
Exhalations  100. 
Expired  air,  odor  of  100. 

Facies  hypocratica  41. 
Facial  nerve,  paralysis  of 

J34. 
Fagopyrism  50. 


240 


Fainting  201. 

Favus  54. 

Feces  ISG,  158. 

— .  retention  of  157. 

— ,  voiding  of  157. 

— .  volume  of  158. 

Fermentation  test  182. 

Fever  65,  67. 

— curve  67. 

— ,  types  of  69. 

Fluctuation  24. 

Flagellosis  236. 

Fleas  51. 

Food,  manner  of  taking^  135. 

Foot  and  mouth  disease  55. 

Foot  eczema  51. 

Foreign  bodies  in  intestines 

166. 
— in  esophagus  164. 
Fowl  cholera  72. 
Friction  bruits  of  pleura  128. 

Garglings  !•(!. 
Garget  197. 
Gastro-enteritis  165. 
Gastro-intestinal    catarrh 

165. 
Glanders  132. 
— ulcer  94. 
-^cicatrices  95. 
Gmelin's  test  180. 
Gram's  method  189. 
Granular  casts   189. 
Granule  casts  188. 
Grape  sugar  182. 
Groaning  96. 
Grunting  96. 
Guttie  of  ox  34,  165. 

Habitus  32. 
Hematopinus  52. 
Hair  coat  43. 


— ,  shedding  of  44. 

Heart  81. 

— beat  82. 

— sounds  84,  85. 

Heave  line  99. 

Heaves  212. 

Hematuria  178,  191. 

Hemidrosis  45,  50. 

Hemiplegia  98. 

Hemiplegia,    larvngis    sinis- 
tra 129. 

Hemoglobinuria  178,  179, 
191,  235. 

Hepatization  27,  122. 

Herpes  tonsurans  54. 

Hippuric  acid  185. 

Hives  50. 

Hog  cholera  71. 

Hvaline  casts  188. 

Hydrocephalus  119,  203,  207. 

Hypesthesia  202. 

Hvperemia  of  kidnevs,  pass- 
ive 191. 

Hyperesthesia  202. 

Hyperidrosis  45. 

Hypertrophy  of  heart  88. 

Hypidrosis  45. 

Icterus  60,  61,  201. 

Immobility  209. 

Impaction  of  intestines  151. 

— ,  rectum  205. 

Incarceration  151. 

Incontinentia  urinae  191. 

Indican  179. 

Influenza  71. 

Inoculation  218. 

— for  anthrax,  etc.  226. 

—for  glanders  222. 

—for  rabies  227. 

— for  tuberculosis  219. 


241 


Insufficiency  86. 

— of  mitral  valves  89. 

— of  semi-lunar  valves  86, 

89. 
— of  tricuspid  valves  89. 
Intermaxillary  lymph  glands 

109. 
Intestinal  catarrh  166. 
— evacuations  156. 
— gases  163. 
— noises  or  sounds  15-1. 
— peristalsis  156. 
Intoxication  19. 
Invagination  35,  152. 
Ischury  ITO. 

Kidnevs,   passive  hvperemia 

of  191. 
Kyphosis  43. 

Laryngeal  catarrh  129. 

Laryngeal  fremitus  117. 

Laryngitis,   croupous    129. 

Laryngoscopy  116. 

Leucocytosis  234. 

Leucemia  235. 

Lice  51. 

Licking  disease  166. 

Lime  casts  163. 

Liver  163. 

Lockjaw  208,  see  tetanus. 

Loco  weed  poisoning  167. 

Lordosis  43. 

Louse  flies  51. 

Lumbago  37,  41,  see  azotu- 

ria. 
Lungs,  congestion  of  130. 
— ,  gangrene  of  130. 
— ,  edema  of  130. 
Lupinosis  167. 
Lymphatic   glands   229. 
Lysis  70. 


Mast  cells  234. 

Macula  49. 

Mai  de  Cederas  236. 

Mai  du  coit  197. 

Malaria  236. 

Malignant  catarrhal  fever 
133. 

— carbuncle  48. 

— edema  57. 

Malingerers  36. 

Mallein  inoculation  222. 

Malleus  132. 

Mange  53. 

— ,  acarus  54. 

— ,  psorpptic  53. 

— ,  sarcoptic  53. 

— ,  sarcoptic,  of  fowls  53. 

— ,  symbiotic  53. 

Mastication  134. 

Mastitis  197. 

Melanosarcoma  142. 

Microcytes  234. 

Milk  fever,  see  parturient 
paresis  37. 

Mites  51. 

Mold  poisoning,  see  mycosis. 

Monoplegia  205. 

Morbus  maculosus,  see  pur- 
pura hemorrhagica. 

Motility  199,  202. 

Mouth  cavity  139. 

Mouth  speculum  141. 

Mycosis  140.      . 

Mydriasis  206. 

Mucous   click  95. 

Muscular  rheumatism  42. 

Muscular  sense  204. 

Myocarditis,  acute  88. 

Nagana  237. 


242 


Nasal  catarrh  129, 

— discharge  !)0. 
- — mucous  membrane  107. 
- — tone,  see  mucous  click  95, 
Nephritis  191, 
Nettle  rash  56. 
Nervous  system  19'7, 
Nodules,  see  papules  50,  108, 
Nymphomania  192, 

Obesity  39. 
Ocular  vertigo  201, 
Estrus  ovis,  larva  of  103. 
Opisthotonus  202. 
O-rthotonus  202. 
Osteomalacea  43. 
Overfeeding  146,  1-49, 
Oxalate  of  lime  184, 

Palpation  23. 

— of  bowels  per  rectum  149. 

Panting  94. 

Papules  50. 

Paraplegia  98,  205. 

Paralysis  204. 

' — of  bladder  170. 

— of  facial  nerve  208. 

—of  the  larynx  130. 

— 'of  esophagus  and  pharynx 

138,  164. 
^— of  paunch  143. 
■ — of  recurrent  nerve  214. 
Parasites,  intestinal  162. 
' — in  cavities  of  head  129. 
Paresis  204. 
Parturient  paresis  37,  70, 

209. 
Pathognomic  symptoms  14. 
Paunch,  paresis  of  149. 
— ,   peristalsis  of  149. 
■ — ,  gases  in  146. 
Pentastonum  tenioides  103. 


Percussion  24. 
Percussion,  field  of  120, 
—of  abdomen  152. 
Pericarditis  82,  89, 
— ,  traumatic,  of  ox  90# 
Peritoneal  hernia  152. 
Peritonitis  34,  166. 
Pernicous  anemia  235. 
Petechia  107,  108,  140. 
Pharyngitis  142,  164. 
Pleuritis  34,  82,  131. 
Pleurodynia  34.  130. 
Pleuropneumonia  of   the  ox 

133. 
— of  the  horse  131. 
Pneumonia  123. 
— ,  catarrhal  130, 
Pneumothorax  131. 
Poikilocytes  233, 
Polyarthritis  42, 
Priapism  192. 
Proctitis  140. 
Prurigo  208,  50. 
Pseudo  fluctuation  24. 
Psychic  functions  199, 
Ptyalism  163, 
Pulmonary,  congestion   and 

edema  130, 
—gangrene  101,  126,  130. 
— resonance  122. 
Pulse  66,  73, 
Pumping  of  flanks  99. 
Purpura  hemorrhagica  56, 

109, 
Pustules  50. 
Pyemia  70. 
Pyelonephritis  191, 
Pyrosoma  bigeminum  236. 
Pyrocatechin  in  horse  urine 

182. 


243 


Quality  of  percussion 

sounds  26. 
Quibbing  137. 

Rabies  205,  208. 

Rachitis  43,  43. 

Rales  127. 

— ,  crepitant  127. 

— ,  dry,   128. 

— ,  moist  127. 

Reflex  excitability  206. 

Reflex  spasms  203. 

Regions  of  the  body  21. 

Regurgitation  120,  125. 

Resistance  in  percussion  28. 

Respiration,  types  of  94. 

— ,  amphoric  126 

— ,  bronchial  126. 

— ,  vague  or  indefinite  126. 

— ,  vesicular  124. 

Respiratory  apparatus  90. 

Retentio  uran^ae  191. 

Return  impulse  114. 

Riding  school  movements 

203. 
Rinderpest  167. 
Rinderseuche  226. 
Ringworm  54. 
Risus  sardonicus  203. 
Roaring  98.   129,  214. 
Rothlaiif  201.  231. 
Rumination   143. 

Saliva,  secretion  of  140. 
Satvriasis  192. 
Saw-horse  attitude  34,  203. 
Scabs  50. 
Scalma  131. 
Sensibility  199.  201. 
Septicemia  70. 
Sexual  apparatus  192. 
—desire  192. 


Sheep  pox  55.. 

Signalment  31. 

Skin  43. 

— ,  color  of  45. 

— ,  exhalations  of  the  46. 

— ,  moisture  of  44. 

— ,  odors  of  46. 

— ,  reflexes  of  206. 

— ,  sclerosis  of  46. 

Skoliosis  43. 

Sleepiness  200. 

Sneezing  96. 

Snoring  95. 

Snorting  94. 

Somnolency  200. 

Sopor  200.' 

Spasms  202. 

Spinal  paralysis  37,  205. 

Spinal  meningitis  203. 

— ,  reflexes  206. 

Spine,  fracture  of  37.  205. 

Spleen  163. 

Stasis  47. 

Starvation  147. 

Stenosis  of  air  passages  314. 

— of  cardiac  valves  86. 

— of  esophagus  164. 

Stenotic  laryngeal  tone  95. 

Stethoscope  29. 

Stomacace  140. 

Stomatitis  163. 

— pustulosa  contagiosa  167. 

Strangles  132,  see  distemper. 

Stranguria  169. 

Strongylus  filaria  130. 

Submaxillarv    lymph   glands 

90,  109.' 
Suflfusions  108. 
Sulphate  of  lime  186. 
Summer  surfeit  50. 
Surra  237. 
Sweating  44,  45. 


244 


Sweeny  49. 


bweeny  4y. 
Swine  erysipelas  4:6. 
Swine  plague  64,  71. 
Symptoms  12. 
Syncope  201. 

Teeth  140. 

- — ,  caries  of  101. 

— ,  diseases  of  164. 

- — ,  gnashing-  of  the  137. 

Temperament  40. 

Tetanus  37,  208. 

Texas  fever  72,  231,  236. 

Thirst,  see  "Desire  for  water 

p.  134. 
Ticks  51. 

Torsion  of  colon  152. 
Torsio  uteri  196. 
Trembling  202. 
Trichodectes  52. 
Tricophyton  tonsurans  54. 
Triple  phosphate  186. 
Trismus  202. 
Trommer's  test  182. 
Tubercle  bacilli  105,  106. 
Tuberculin  test  219. 
Tuberculosis  131,  193.  . 
Tumors   in   cavities  of  head 

129. 
Turnsick  201,  203,  208, 
Tympanitis  165. 
—acuta  144,  165. 
— chronica  144,  165. 
Tzetse  disease  237. 

Udder  194,  196. 

Ulcers  140. 

' — catarrhal  or  erosion  108. 


Upper  air  passages  106, 
Uremia  201. 
Urethral  calculi   190. 
Uric  acid  185. 
Urinary  apparatus  167. 
—casts  188. 
Urination  167. 
Urine,  sediment  in  184. 
— ,  voiding  of  KJT. 
Urticaria  56. 

Vaginal  mucous  membrane 

'  194. 
Vaginitis  197. 
Valvular  diseases  6S. 
Veins  80. 

— ,  undulation  of  jugular  80. 
Venous  pulse  81. 
Verminous  broncliitis  130. 
Vertigo,    201,    216,   217. 
Vesicles  50. 

Vesicular  eruption  193.  197. 
Vesicular  murmur  124. 
— respiration  125. 
Voice,  change  in  115, 
\^omiting  144. 
— in  horses  144. 

Water,  desire  for  134. 
Whistling  96,  215. 
Woody  tongue  136. 
Wool  eating  151. 
Wool  in  feces  162. 
Wheezing  94. 

Wild-und   Rinder-seuche  57, 
226. 

Yawn  94. 


